Early detection is key for insurers looking to stem the costly insurance claims fraud problem. Unfortunately, with caseloads rising, it is challenging for overworked claims staff to keep a watchful eye on suspicious behavior that may indicate a fraudulent insurance claim. Today, we at Advanced Private Investigator & Security of Miami, FL would like to offer some tips on identifying fraud in insurance claims.
Search for Patterns of Fraud
Most know history repeats itself and fraud is no different. It’s pretty easy to see the pattern if a scammer files several problematic claims with a single insurance company. They can fly under the radar of a carrier’s internal detection system, which is why fraudsters often target multiple insurance companies. As a first step in stopping insurance claims fraud, checking the full scope of claims information for matches is essential. Regarding the property/casualty industry specifically, the industrywide claims data in ClaimSearch® provides access to billions of claims details. It can reveal prior-loss histories that may show the damage that’s being claimed today was also part of an earlier claim, or several when the system matches an incoming claim. Adjusters can also easily see red flags of potential fraud.
Tap Multiple Sources to Detect Claims Fraud
It’s essential to have a 360-degree view of the claim when there’s reason to believe an insured loss is suspicious. For example, the property, body shop and medical providers on the claim may have clues to insurance fraud that could lie in details about the insured. Investigators can analyze detailed vehicle data, medical records, social media posts, criminal records and much more. In addition, investigators may wish to pull a report that shows geo-tagged, time-stamped license plate photos from around the country, in an auto theft claim, for example.
Discover Missing Links that Uncover Organized Insurance Fraud
Much like seeing the strands of a spider web, investigating insurance fraud is far-reaching and plentiful, with multiple points of connection when an organized insurance fraud network is revealed. Because organized insurance fraud rings can sweep across regions and even state lines with schemes involving many insurance carriers, your claims office would likely see only one part of the bigger swindle. Unfortunately, insurance fraud rings are big business, and they can score millions of dollars in claims. Typically, criminals lead these rings who trade in staged car crashes, unscrupulous medical providers, on-the-take body shops, fake injuries and crooked lawyers. Having a broader view of claims beyond your own insurance company is vital.
Identifying Medical Provider Fraud in Bodily Injury Claims
Although challenging, it is a worthwhile endeavor to seek out scams while detecting fraud in property/casualty claims with an injury component. During a single year, one study estimated that billions in auto bodily injury claim payments were fraudulent. Prescribing overly expensive treatments, billing for unnecessary diagnostic tests, and using complicated billing codes as a smoke screen are involved in medical fraud. It can be a huge challenge for insurance adjusters to find fraudulent behavior when their schedules are spread so thin with rising caseloads.
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Additional tactics include using predictive analytics to screen claims quickly, managing complex insurance fraud cases, and using the right tools to fight insurance fraud. With the help of Advanced Private Investigator & Security of Miami, FL, insurance fraud can be uncovered and even prosecuted to achieve justice in these cases as well as deter others.
