Insurance & More

Examples of Homeowners’ Insurance Fraud:

• Staging a phony burglary or vehicle break-in and faking a loss

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Examples of Health Insurance Fraud:

• 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

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Workers’ Compensation Insurance Fraud include two sets of crimes:

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Examples of Auto Insurance Fraud include:

• 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”)
• Driving and getting into an accident when you are uninsured. Then obtaining insurance and falsely stating the date and time of the accident in an effort to have the claim paid.

Fraud occurs when someone knowingly lies to obtain some benefit or advantage to which they are not otherwise entitled or someone knowingly denies some benefit that is due and to which someone is entitled. Depending on the specific issues involved, an alleged wrongful act may be handled as an administrative action by the Department or the Fraud Division may handle it as a criminal matter. 

In PA there are 4 type of Insurance Fraud; Auomotive, Workers’ Compensation, Health Insurance and Homeowners’.Check back on 5/26 for more details on auto, 5/27 for Workers Compensation, 5/28 for Health and 5/29 for Homeowners.