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A Spike in Insurance Fraud Across the U.S.

As you may have guessed, the country’s economic conditions have caused a nationwide spike in insurance fraud.

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A recently released report by the Coalition Against Insurance Fraud points to the economy and continuous pressures on state budgets as the reason for a spike in fraud cases.

Overall, the economy in 2009 appears to have had a significant impact on the incidence of fraud.

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On average, fraud bureaus reported the number of referrals received and cases opened increased in all 15 categories of fraud

included in the survey.

Overall, the economy in 2009 appears to have had a significant impact on the incidence of fraud. On average, fraud bureaus reported the number of referrals received and cases opened increased in all 15 categories of fraud included in the survey.

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Those 15 categories of fraud are:

  1. Agent fraud
  2. Auto – staged
  3. Auto – padding/false claim
  4. Auto – give up
  5. Commercial – arson
  6. Disability
  7. Drug diversion
  8. Homeowners – arson
  9. Homeowners – padding/fake
  10. Liability – false claim
  11. Life insurance
  12. Medical – false claims
  13. Work comp – worker
  14. Work comp – employer
  15. Bogus health insurance/discount health plans

The biggest number of fraud cases occurred in the area of bogus health insurance. The report pointed to the reported rise in unauthorized entities selling fake coverage combined with the emergence of medical discount plans as the reason for the dramatic spike in this area.

Drug diversion came in second with survey respondents pointing to the fact that fraud involving the diversion of prescription drugs, mainly painkillers, appears to continuously increase — a trend over the last few years.

Insurance Fraud to Rise in 2010

We know all too well that insurance fraud (and many other illegal money-making schemes) ramp up in down economies. But what sector of insurance will it hardest in the new year?

According to National Underwriter and the Coalition Against Insurance Fraud, the answer is health insurance. In a survey of 37 fraud bureaus, the Coalition found that the selling of bogus health insurance to small businesses is now the “number one scam.” Other healthcare-related fraud consumers should expect to see in 2010 include medical provider fraud in auto injury and workers comp cases.

Interesting to note is another fraud scheme that has seen a spike during recent, more desperate times — that of the “slip and fall.” Dennis Jay, executive director of the Coalition, stated that incidences of fake slips and falls are “really going through the roof.

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And let us not forget computer hacking fraud.

Ed Goodman, chief privacy officer at Identity Theft 911, said at this point he thinks insurance losses from this kind of crime are difficult to quantify because “the insurance industry is very tight-lipped about it,” and “some numbers you see on the cost of data breach losses are questionable.” However, he guessed that the damage “could well be in the hundreds of millions” and involve soaring legal costs.

As with healthcare-related fraud, computer fraud is more common among small businesses due to lack of appropriate tech security resources.

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The following are seven ways small businesses can prevent computer hacking, thanks to AllBusiness.com:

  1. Implement a firewall
  2. Develop a corporate security policy
  3. Install anti-virus software
  4. Keep operating systems up to date
  5. Don’t run unnecessary network services
  6. Conduct a vulnerability test
  7. Keep informed about network security

Fraud in any form means lost revenue, and in these economic times it’s important for companies to increase protection measures and risk management efforts. What type of fraud is your company preparing for in 2010 and how?

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