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Types of fraud
Examples of auto insurance fraud:
Examples of homeowners' insurance fraud:
- Staged accidents, where one or more criminals cause intentional collisions in order to get undeserved payments for health care costs for alleged injuries or vehicle damage.
- Providing false information to an insurance company about a car's mileage or use.
- Phony injury claims, when people lie about the injuries they have sustained in an accident.
- Inflated damage claims, in which criminals falsify the extent of damage or the true cost of repairs to their vehicles.
- Phony thefts, where the owner simply abandons a vehicle and then claims it was stolen (known as an "owner give-up").
- Falsely claiming a one-car accident was a "hit and run."
- Inventing injuries to people who were not in a vehicle at the time of the accident (people known as "jump-ins")
Examples of health insurance fraud:
- Staging a phony burglary or vehicle break-in and faking a loss
- Overstating the value of stolen items after an actual burglary of a home or vehicle
- Lying about the extent, cause, date or location of legitimate damage
- Intentionally damaging property
- Making a second claim for a loss that was already paid for by another insurer or through a prior claim
- Asking a repairman to "cover your deductible" within their estimate
- Fabricating supporting evidence - often in collusion with a crooked contractor, plumber, repairman or insurance adjuster
- Doctors billing insurers for a more costly service than the one performed (also called upcoding)
- Providing services such as tests, surgeries or other procedures that are not medically necessary to get additional payment
- Billing for services not actually rendered (often using genuine patient names to fabricate entire claims)
- Billing each stage in a procedure as if it were a separate procedure (known as "unbundling")
- Accepting kickbacks for referrals
- Organized criminals setting up a phony clinic solely to generate fraudulent claims
- Patients forging receipts to get unwarranted reimbursement from an insurance company
- Patients embellishing, adding to or just plain lying about services received
- Patients who ask their doctors to falsify a report to an insurer to cover a non-covered procedure
- Patients who ask a doctor to waive their copayments
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