Arson-for-Profit - Exactly what it says. Someone
burns something to make a buck.
Disaster Fraud - Fraud that occurs when bad guys
grab a piece of the pay-out action from a disaster victim - or they
contract to do repairs and never complete the work.
Exaggerated Claims - Padding a claim. Consumers pay
billions of dollars annually to cover these "little exaggerations".
Falsifying Theft Reports
- Lying for dollars. Claiming things were stolen that weren't.
Kickbacks - Money is paid to providers, lawyers,
cappers/runners or any combination of these to provide patients or
clients to the professional to represent or treat.
MEDICAL FRAUD TERMS:
Medical Mills - Medical clinics
that derive the majority of their income via fraudulent means.
Padded Bills - Adding fraudulent
aspects to medical bills. For instance, a patient might come in for
a simple office visit, but the clinic will bill the insurance
company for x-rays, blood tests, and other things that were never
provided.
Medicaid or Medicare
- Insurance programs run by state or federal agencies that are high
targets by scammers.
Unbundling Bills - Procedures that
are typically billed under a single global code, but are billed
individually to increase the profit.
PERSONAL INJURY SCHEMES TERMS:
Slip and Fall -
Usually a staged mishap; most often taking place in a place of
business. The person who falls will make an injury claim for
nonexistent injuries.
PROPERTY FRAUD TERMS:
Multiple Policies for
Profit - A person purchases multiple policies to
insure the same thing. Then there is an intentional loss and they
attempt to collect on all of the policies.
VEHICLE FRAUD TERMS:
Swoop and Squat -
An intentionally caused auto accident. Car #1 swoops in front of Car
#2. Car #2 slams on his brakes. Car #3 (that's the innocent victim)
rear ends Car #2. The driver and passengers in Car #2 claim injuries
against Car #3's insurance company.
Drive Down - Car #1 signals Car #2
that it's okay to proceed. When car #2 pulls out, Car #1
intentionally hits him. The accident, of course, is blamed on Car
#2. The driver and passengers of Car #1 claim injuries.
Paper Accidents - Accidents that
happen only on paper.
Staged Accidents - An "accident"
wherein the parties involved create a scene to make it appear as
those an actual accident occurred.
Hidden/inflated Repair Costs - Dishonest auto body
shops inflate a damage estimate so that the car owner does not have
to pay his/her deductible.
Policy Misrepresentation - Someone
getting an insurance policy misrepresents an important piece of
information to get a lower rate.
Owner/Lessee Give-up - Vehicle owner/lessee
arranges for his own car to be stolen -- and hands it over to the
alleged thief. Then he files a claim that says his car was stolen.
WORKER'S COMPENSATION FRAUD TERMS:
Employee Fraud - A fraudulent
claim filed by an employee against his employer's insurance policy.
Or...false information provided by an employer on his application in
order to obtain a lower rate than the one to which he is entitled.