Insurance fraud is a considerable financial cost for providers, insurance companies, and the economy at large, with higher costs in premiums. Individuals or organizations deliberately misrepresent to present fraudulent information to receive benefits or payments that they do not, in fact, deserve. According to industry estimates, insurance companies are losing about $80 billion every year in all insurance sectors due to fraudulent claims. Knowing which types of insurance are fraudulent at the highest rates assists companies in implementing the targeted prevention methods. Insurance fraud private investigators in Oklahoma City specialize in detecting fraudulent claims and acquiring evidence that insurers need to safeguard themselves from financial losses through fraud.
Health Insurance Fraud Volumes Dominate All Categories
Medical insurance fraud is the most common type of insurance fraud across all insurance companies. In addition to billing for services that providers did not render, health insurance fraud also includes upcoding and rendering unnecessary medical procedures. Insurance fraud private investigators in OKC document instances wherein medical providers submit double claims and charge for more costly operations than they had performed. In addition, patients will often give insurance cards to uninsured patients, thus creating identity fraud scenarios.
Prescription drug fraud is an ever-increasing problem in healthcare insurance schemes. Therefore, investigators follow patterns of doctor shopping, whereby patients visit different physicians to collect conflicting prescriptions. Furthermore, some pharmacies charge insurers for drugs that they never gave to patients. Insurance companies hire private investigators in my area for their identity checks of medical records against application claims. Medical billing is so complex that it offers a lot of opportunities for fraudulent behavior, which requires specialized investigative skills.
Auto Insurance Fraud is the Second Most Common and Costly Fraud
Vehicle insurance fraud divides into staged conflicts, overused havoc policies, false passenger schemes, and phantom passenger schemes. Fraudsters rig staged collisions as intentional accidents to masquerade as if they were not intentional to create insurance pay-outs. Additionally, organized fraud ring members organize many accidents, with the same participants driving different cars. Insurance fraud private investigators in Oklahoma City examine suspicious patterns of accidents and interview the witnesses to investigate orchestrated schemes.
Fraudulent repairs and unnecessary parts replacement are the largest portion of the auto insurance fraud expenses. Furthermore, there are some repair shops that work with claimants to file fraudulent estimates that are higher than the actual cost of the damage. Furthermore, since claimants report previously incurred damage as accident-related injuries, the investigators document cases for this as well. Process servers in Oklahoma City serve legal papers and collect witness testimonies regarding the condition of vehicles and claimants’ activities.
Workers’ Compensation Insurance Has High Incidents of Fraudulent Claims
The other type of fraud in the workplace takes place when employees feign injuries, overstate their actual injuries, or keep collecting benefits after they heal. Many workers’ compensation scams involve people who claim to have been injured at work when, in fact, they sustained injuries outside of work. In addition, insurance fraud private investigators in Norman, OK, perform surveillance to document physical activities that are not consistent with the disabilities that the claimant is reporting. These investigations show claimants engaging in strenuous activity at the exact time they are claiming total incapacity.
Extended Leave Abuse: Employees go through unnecessary extended recovery to avoid getting back to work. Therefore, investigators follow claimants if they are involved in side employment, housework, recreational activities, and other tasks that experimentally evidence physical exertion. Also, some of the employees falsely attribute the job-related illnesses to the work conditions. In Edmond, OK, private investigators have specialized in documenting the evidence that goes against medical records presented with compensation claims.
Property and Homeowners Insurance Fraud Produces Billions a Year
Arson for profit is one of the most serious acts of property insurance fraud. Some property owners destroy or damage insured property for the purpose of collecting settlement money from their insurance policies. Furthermore, insurance fraud private investigators in Oklahoma City scrutinize patterns of fires, financial reports, and ownership reports with the aim of recognizing questionable situations. These investigations have often found financial hardship as a motivation for making claims they did not deserve.
Inflated property damage claims involve penalties that occur when homeowners report losses on actual events, such as storms or theft, in a larger administrative way than they really are. As a result, claimants submit receipts for items they have never owned or exaggerate the replacement value of damaged assets. Also, some people commit burglaries by stealing valuables before reporting the thefts to insurance companies. Investigators typically assist process servers in Norman, Oklahoma, who find out the conditions of the property and the behaviors of occupants.
Life Insurance Fraud Involves Sophisticated Schemes and Serious Crime.
Funeral fraud is the most extreme form of life insurance scam. There are elaborate plans to achieve this with falsified death certificates, staged accidents, and buried identities in foreign countries. In addition, sometimes beneficiaries hide information related to the deaths of policyholders to continue receiving benefits illegally. Insurance Fraud Edmond, Oklahoma, private investigators examine suspicious death claims by using document verification and witness interviews.
Application fraud occurs when someone misrepresents themselves in terms of health, lifestyle choices, or risk at the workplace for taking on policies. Consequently, insurers conduct full-fledged background investigations before approving policies of high value. In addition, some applicants can try to keep their pre-existing conditions or dangerous hobbies secret in order to keep their premium calculations low. Private Investigators in Oklahoma City check application information by checking medical records and monitoring activities.
Other Steps Premium Companies Take to Prevent Fraud
By cross-referencing claims on data sets against historical data, fraud detection technologies detect questionable claim patterns. Insurance companies use artificial intelligence algorithms that identify anomalies for which an investigation is needed by a human. Moreover, these systems look for duplicate claims, strange billing patterns, and clusters of geographic fraud. Process servers in Edmond, OK, are helpful in giving notice and obtaining testimony on fraud investigations when investigative requests and legal notices require delivery.
Claims investigators in insurance companies work with external investigators to identify high-risk claims. These teams will review patient records, perform surveillance operations, and interview witnesses in order to ascertain the validity of claims. Additionally, insurance fraud private investigators in OKC offer expert witness testimony in actions against fraudulent claimants. Their professional records make evidence admissible in criminal and civil court cases.
Conclusion
All types of insurance face fraudulent claims, though health insurance, auto insurance, and workers’ compensation are the top three types of insurance with fraudulent claims. Property and life insurance fraud are very sophisticated crimes that require specific investigative skills. Professional investigators use surveillance practices, document research, and witness interviews to uncover fraudulent activities. To ensure they do not lose money as a result, insurance companies take the necessary prevention measures, such as data analytics and dedicated investigation units. If your insurance company requests a professional investigation, contact experienced professionals who are familiar with the legal requirements in the state of Oklahoma. For detailed fraud investigation services, contact (405) 593-3515 or contact by email at info@ojpslegal.com.
