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What are insurance fraud investigators looking for?

On Behalf of | Nov 27, 2017 | Firm News, White Collar Crimes |

Like almost everyone, you are probably on the lookout for ways to improve your financial situation. This may mean hunting for bargains, cutting back on expenses and finding ways to bring in a little extra cash. If you are a Louisiana business owner, you know the importance if increasing your cash flow and being frugal with your spending.

However, some people may unknowingly commit insurance fraud to make extra money. In many cases, this is “soft fraud,” which involves exaggerating or being less than truthful on a claim. And there’s also “hard fraud,” which typically involves intentionally fabricating a claim. While some people see fraud as a victimless crime, the insurance companies and the federal government see it differently. If you are under investigation for insurance fraud, your concerns and worries are well-founded.

Common insurance fraud schemes

Insurance fraud takes many forms, and some people go to great lengths to collect on fabricated claims, including any of the following:

  • Medical providers bill insurance companies or Medicaid or Medicare for procedures, tests or treatments that were never performed or that were unnecessary.
  • People claim fraudulent property damage.
  • Multiple people work together to stage car accidents and file claims for damages and injuries.
  • People sell valuable items and file a claim that the items were stolen.
  • It isn’t just in the movies that people fake their own deaths so their beneficiaries can claim the life insurance payout.

Why am I under suspicion?

Because insurance companies deal with so many incidents of fraud, they are on the lookout for signs that a policyholder may be trying to get away with a false claim. Some common indicators alert agents that a claim is potentially fraudulent, including:

  • You were struggling financially when suddenly your home or business sustains serious damage, such as a fire.
  • You increased the insurance coverage on your home or business just prior to making a claim.
  • There is no police report concerning the incident you claim damaged your home or business.
  • No witness reports are available to corroborate your details of the incident.
  • You delay filing a claim.
  • You have filed many claims in the past, even with other insurance companies.

If an insurance company recognizes any of these red flags in your claim, the insurer will likely send investigators to delve more deeply into the incident. These investigators are looking for evidence that you committed fraud, and if they believe they find any, the investigators will likely contact state or even federal authorities. Depending on the circumstances, you may be facing felony charges, and you would do well to seek legal assistance as soon as you are aware that an investigation against you is underway.