Seeing Things in a Different Light

How we see ourselves can be very different from how others see us. The owner and operator of a medical staffing company and home care services provider in Pennsylvania definitely saw herself in a different light than the government prosecutors who went after her for stealing more than $1 million from Medicaid. On the woman’s company website, she describes herself as an “experienced nurse with impeccable skills.” However, a more accurate explanation may have been an “experienced fraudster with impeccable skills in deception.”

Over a two-year period, the business owner carried out her scam by creating fake identification documents and bogus occupational licenses for some of her employees. She also submitted bills to Medicaid for services that were either not provided by her employees, were provided by someone other than the person that claimed to provide the services, or were not provided by a qualified employee at all. (That’s a pretty scary thought. Who would want to receive medical care from someone who was not qualified to give it?)

Although the woman had the right credentials and certifications to run her company, she was anything but impeccable. The 49-year-old pleaded guilty to making false statements about health care matters, engaging in monetary transactions involving criminally derived property and identity theft. She was sentenced to three years in prison and ordered to pay back $1,184,224 and forfeit $656,421.
In addition to claiming that she had “impeccable skills,” the company website also stated that the business “would not shield any errors or omissions to protect our image.”

It looks like the government is holding this woman to her word. Let’s hope that she spends the next three years behind bars examining her lack of character and will emerge with a more accurate self-image and remorse for her illegal actions.

Growing A Crop of Fraud

The American Farm Bureau Federation states that farmers and ranchers only receive 16 cents out of each dollar spent on food. The remainder goes to “wages and materials for production, processing, marketing, transportation and distribution.” (Sometimes, when there’s a bad year and crop production is down, it’s hard to make ends meet. But that was not the case in this situation.)A Missouri farmer, who collected more than $448,000 in crop insurance benefits he did not deserve, ended up reaping a prison sentence instead of a bountiful crop due to his fraudulent claims.

An article posted on WPSDLocal6.com indicates that over five years, the Missouri man illegally received $240,367 in insurance payments in the name of a farm he owned and operated. Additionally, he obtained another $207,729 in insurance indemnities, premium subsidies and administrative subsidies he did not qualify for.

And that’s not all. Investigators discovered that the man also transmitted “Extended Work Search Waivers” to the Missouri Division of Employment Security reporting that his employees had been temporarily laid off when in fact they were working and receiving a paycheck. These fraudulent activities occurred over five years and caused more than $60,000 in unemployment Insurance benefits to be paid to employees that were not eligible to receive them.

The 49-year-old fraudster pleaded guilty to making false statements about crop insurance benefits, theft of government property and wire fraud. He was sentenced to prison for two years.
Further research revealed that the man owned and operated multiple farms and related businesses. His scam involved putting the businesses in other people’s names in order to receive the insurance payments he would otherwise not qualify for. (Perhaps a two-year stint in prison will help this offender to weed out his criminal tendencies so that he can grow in character.)

5 Most Common Types of Insurance Frauds You Should Know Of

Surprisingly, insurance fraud is viewed as a victimless offense. When insurance companies are cheated, it is the people who pay premium on a timely basis that suffer the most. This is because their insurance cost goes up. It’s saddening to know that the losses suffered by insurance companies because of perpetrators are in turn borne by honest people.

According to statistics, around $80 billion losses are incurred annually on account of insurance frauds.

However, not many people know that we, as individuals, can play an essential role in preventing insurance frauds. For this, we need to be aware of the most common types. Stated below are the 5 most common types of insurance frauds:

1.     Stolen Cars

Offenders make use of stolen cars to commit an insurance fraud in two ways. Firstly, if a legitimate owner sells the car to a body shop owner for spare parts, it could be considered stolen. Since the body shop is also a faction of the scheme, the legal authorities wouldn’t  be able to find out that an insurance fraud has been committed. Secondly, criminals hide their car and make claims that it has been stolen. Moreover, the insurance company wouldn’t be able to draw out money from the car owner even after the car is located.

2.     Car Accidents

Many of the accidents that happen around us are actually insurance frauds taking place. Insurance fraud accidents are staged where the driver and the victim are co-conspirators. Sometimes, the fraud is planned on such a massive level that it involves fake witnesses and insurance investigators as well. Moreover, in such fraud claims, the value of the car that got hit and the value of the car that hits the victim’s car are greatly hiked. Likely so, the cost of the damages is also inflated.

3.     Health Insurance Billing Fraud

It is quite appalling to know that healthcare professionals are often involved in such conspiracies. Some basic examples of common frauds they commit include billing the insurance company for treatments that was never provided, or hiking the value of the work that was done. For instance, if a patient comes in for a regular checkup, the doctor would bill the insurance company for an in-patient surgery. Here, the patient may be the real victim of fraud but would have no knowledge of it.

4.     Unneeded Medical Procedures

If you ever come across a situation where your doctor is prescribing you tests unnecessarily, or ones you feel don’t pertain to your condition, you might be a victim of insurance fraud. For example, if you are suffering from a leg sore and your doctor asks you to get some blood and stool tests done, you are likely to get confused as to the reason behind this test.

5.     Faked Death

This is one fraud that has stemmed from movies, books and TV shows. In such kind of insurance frauds, the criminal will file an insurance policy of his own life, making the spouse as the only beneficiary. After months, the fraudster will fake his/her own death and all the money and benefits will go to the spouse. Post funeral, the spouse may relocate where they reunite and enjoy the claimed money.

Have you been a victim of a ruthless insurance fraud? If yes, then you surely need the assistance of an insurance fraud investigator such as National SIU. This private investigations firm has a special investigations unit so that you can be provided with evidences that reveal the real side of the case. Browse their website http://www.nsiu.com/home for more information.

Insurance Fraud Numbers in the US

You can put stock in one industry to do well despite the recession, but it’s unlikely to show up on the NYSE. Insurance fraud has been the favored crime for unethical white-collar workers looking to fake injuries, and they’ve also began denting their cars, to claim a quick bundle. According to the National Insurance Crime Bureau (NICB), questionable claims went up by 27% between 2010 and 2012. That figure breaks down to 9% between 2010 and 2011, and 16% between 2011 and 2012. Insurance fraud investigators must have had a heyday.  

Rising fraud insurance claims is hardly a US phenomenon. In the UK, bogus car insurance claims went up by 20% since 2012. Fake car crashes led to a combined fraud of £811m in 2013, with the total fraud up by 18% over the previous year.

Regional winners

The cities with the highest levels of insurance fraud were New York with 13,564 questionable claims, Los Angeles with 7,779, Miami with 5,503, Houston with 5,464, and Baltimore with 3,690.

State-wise, California lead the way by a huge margin with 58,415 suspected cases of fraud from 2010 to 2012. Following were Florida with 29,086 cases, Texas at 27,107, New York at 23,402, and Maryland at 10,315. Population-wise, the states most vulnerable to insurance fraud were Kentucky, where suspected fraud levels rose by 89%, Vermont by 88%, Rhode Island by 81%, Alaska by 75%, and Maryland by 70%.

Popular schemes

Said to be the easiest kind of insurance fraud, deliberately damaged cars made up the bulk of nationwide fraud cases, with 209,724 suspected fraud claims. Home insurance was the second most common source of insurance scam, with 40,747 questionable claims, after which worker salary and liability policy scams accounted for 11,151 cases. Commercial car and liability insurance generated a combined 17,031 cases. However, fire insurance and personal property insurance companies breathed a little easy, since they saw the number of questionable claims drop slightly from 2010 to 2012.

Those slipping and falling their way to insurance claims were under the radar, with insurance companies referring over 50,000 cases to the NICB and surveillance investigators for review. Also under scrutiny were questionable theft of heavy equipment and vehicles with 35,508 questionable claims, miscellaneous property damage or prior loss at 29,646 claims, suspicious loss of miscellaneous belongings at 29,017 claims, and suspicious loss or theft of belongings at 24,867 claims.

Insurance scams are common because instigators often encourage customers and family members to use them to save some money, making the scams look easy. As a result, innocent insurance customers have to pay higher rates and premiums. If you suspect or know someone of participating in insurance fraud, don’t be an onlooker – inform the authorities.

Staycation

In 2012, Superstorm Sandy was one of the most destructive hurricanes to ever blow up the Atlantic coastline, ultimately causing an estimated $65 billion in damage. The second most-costly hurricane in U.S. history also opened the floodgates for fraudsters to take advantage of the Federal Emergency Management Agency’s (FEMA) Transitional Shelter Assistance (TSA) program. Today’s “Fraud of the Day” focuses on the owner of a New Jersey motel who attempted to steal tens of thousands of dollars in disaster relief funds he did qualify for nor deserve.

FEMA’s TSA program provides evacuees with short-term lodging assistance when they are unable to return home following a disaster due to inaccessibility or uninhabitable conditions. If eligible, disaster survivors are allowed to stay in a hotel or motel for a limited amount of time and FEMA will cover the room and taxes associated with their stay. (Incidental charges, room service and pay-per-view binges are not allowed.)

A New Jersey motel owner got into trouble after fraudulently obtaining more than $80,000 from the TSA program. His scam involved billing FEMA for 11 individuals, but in reality only three of them actually stayed at the motel. (FEMA paid the motel owner $133.28 per day for each room occupied by the storm victims.)

The motel owner also fraudulently billed the disaster relief program for stays of multiple weeks or months, when that didn’t really happen. Then he tried to use the names of relatives who lived in the area, but were not displaced by the storm to submit claims worth more than $50,000. (This fraudster must have mistakenly believed that FEMA was in the business of paying for staycations.)

The 44-year-old motel owner pleaded guilty to theft by deception and was sentenced to three years in prison for fraudulently claiming that his establishment temporarily housed Superstorm Sandy victims. He has already paid full restitution of $81,567.

FEMA’s TSA program is intended to provide relief funds for disaster victims, not become a source of additional income for fraudsters trying to make some easy money. While Superstorm Sandy may have led criminals to believe that it opened the floodgates to steal undeserved government funds; however, the Justice system has definitely slammed the jail cell door shut on this fraudster and many others. (It looks like he’ll be spending the next three years on a different type of staycation.)

With a Prompt Evidence Turnover Service, NSIU Delivers Superior Results to Clients

Efficiency is a specialty of NSIU and it is evident in their evidence turnover service, which allows them to deliver favorable results to clients

Many investigation agencies can offer clients surveillance and investigation services, but delivering timely results is what separates average investigators from the elite ones. Stretched out insurance fraud investigations don’t benefit anyone but the fraudsters. So, it is safe to say that promptness is one of the best qualities that an insurance investigation agency can have.

NSIU prides itself on the efficient and timely services that it offers to its clients. The best part of these timely services is the prompt evidence turnover service, which ensures that the clients receive the proof of any wrong doing, right after the investigators learn about it.

The agency utilizes their innovative virtual CASELINK to accomplish the task of prompt turnover of evidence. NSIU’s CASELINK is a virtual case management system which gives clients access to any and all evidence that the investigators have gathered on the case.

The best part about the CASELINK is that it is accessible to clients from anywhere and it is available 24/7, so the clients can access their case files whenever and wherever they want. And the clients don’t have to worry about the security of the case files either; the CASELINK is secured by a 256-bit encryption, which should give the clients peace of mind about the protection of their access to the CASELINK.

A representative from the agency was asked to comment on the topic and this is what they had to say, “As soon as our investigators have gathered evidence on any particular case, it is filed in the CASELINK. Clients can then access it from wherever they are. If the clients need us to turn over the evidence in person, then we can also accommodate that request. Our investigators will gather the evidence and deliver it to the client’s location.”

Prompt turnover of evidence is not the only advantage that clients receive, when they work with NSIU. The biggest advantage is the flat-rate pricing that the agency offer to their clients. This pricing method provides clients with the benefit of saving hundreds of dollars during an investigation.

With decades of experience under their belt, the investigators at NSIU know how to handle any type of insurance fraud investigation. They make sure that the truth is uncovered in all the investigations they handle and that their clients can avoid any possible losses.

About the Company

National SIU (Special Investigation Unit) is a professional investigation firm that specializes in surveillance and other services specifically for risk managers and insurance professionals. The organization’s main goal is to provide their clients with effective evidence which can be used to uncover the truth.

Contact Information

Website:             http://www.nsiu.com/home

Toll-free:             800.960.NSIU (6748)

Fax:                        800.293.6748

Email:                   contact@nsiu.com

Address:              National SIU Headquarters, 869 E. Schaumburg Road, Suite 376, Schaumburg, IL 60194

LinkedIn:             https://www.linkedin.com/company/nationwide-s.i.u.

Twitter:                https://twitter.com/nsiuinsurance

Decades of Lying

One way that criminals defraud the Social Security Administration (SSA) is by failing to notify the agency about the death of a beneficiary, then they continue to receive and cash the checks of their deceased loved one. Today’s “Fraud of the Day” spotlights two men who failed to inform the SSA that their parents had died. Together, they stole more than half a million dollars from the agency.

One man, who was 70 years old, continued to collect his father’s benefit checks for approximately 34 years. When asked about his father’s location, the man claimed his father had run off with a younger woman and was nowhere to be found. (That’s pretty amazing for a man that was apparently in his 90’s.) His lies enabled him to receive $241,171.60 he did not deserve. He was sentenced to 10 years in prison, three years of supervised release following the jail time and was also ordered to pay full restitution.

Another man, 68, completed and submitted 11 annual certifications to the Defense Finance & Accounting Services (DFAS) swearing his mother was eligible to receive benefits, even though she was actually dead for more than a decade. He also failed to inform the SSA of her death. He received $271,819 from his mother’s SSA spousal benefits and DFAS survivor benefits. This fraudster was sentenced to 15 months in prison, three years of supervised release and ordered to pay restitution of $254,965.14.

While the SSA Death Master File contains information about many deceased citizens, these two cases show that without proper notification and cross-checking efforts across multiple relevant databases, sometimes Social Security fraud can go undetected for decades. However, there is one thing you can count on – no matter how long it takes, the government will go after those who deceive and steal from those who qualify for and deserve Social Security benefits.