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Subscription Not Required
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NCOIL
TO DEFLATE AIRBAG
SCAMS, PURSUE MODEL LAW |
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A fraud by any other
name
is still a fraud |
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The John Cooke Fraud Report is restricted to the fraud
detection industries. Investigators share their tips
and knowledge with us to help their peers, not their
antagonists; accordingly this publication will never be
offered to the general public. To subscribe to the
John Cooke Fraud report, please click
HERE. |
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_____________________
L. Burke Files
Due Diligence — Giving
Away Data
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Washington, DC, March 3, 2009
— Lawmakers at the National
Conference of Insurance Legislators (NCOIL) Spring Meeting here
vowed to pursue model legislation that would take wind out of airbag
fraud—scams in which, through theft and insurance misdealing, auto
repair shops and other entities jeopardize consumer safety to chase
monetary reward. The March 1 Property-Casualty Insurance Committee
decision commits the group to considering a model based on current
state approaches.
Of
interest to legislators is requiring body shops to show an airbag
bill of sale before insurer reimbursement;
MORE |
© 2008
Barry Zalma, Esq., CFE
The United States Ninth Circuit Court of Appeal has
recognized that the Americans With Disabilities Act ("ADA"), a law
with great intentions, that fell afoul of the law of unintended
consequences. The abuse of that law has created an industry of
litigation that is more like extortion than an attempt to redress
wrongs.
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What Insurers Can
Do about Escalating Medical Fraud in Health and
Property/Casualty Insurance |
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Gotchas |
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Alabama
Alaska
Arizona
Arkansas
California
Colorado
Connecticut
Delaware
Dist. of Columbia
Florida
Georgia
Hawaii
Idaho
Illinois
Indiana
Iowa
Kansas
Kentucky
Louisiana
Maine
Maryland
Massachusetts
Michigan
Minnesota
Mississippi
Missouri |
Montana
Nebraska
Nevada
New
Hampshire
New
Jersey
New
Mexico
New
York
North Carolina
North Dakota
Ohio
Oklahoma
Oregon
Pennsylvania
Rhode Island
South Carolina
South Dakota
Tennessee
Texas
Utah
Vermont
Virginia
Washington
West Virginia
Wisconsin
Wyoming |
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By Dr. Barry L. Johnson
Fraudulent medical schemes are a growing problem in
the health and property/casualty insurance sectors. In fact, they
are the largest issue facing the industry today. Unfortunately, the
volume and expansion rate of medical fraud is uncontrolled in
comparison with other property/casualty risks. The Insurance
Research Council (IRC) estimates that fraud and abuse losses in the
health care industry waste an estimated $70 to $255 billion annually
and contribute to rising expenditures. In addition, 18 to 27 percent
of bodily injury claims and 12 to 17 percent of personal injury
protection claims contain the appearance of buildup or fraud.
Perpetrators of such fraud range from insureds, members and
providers, all the way to organized fraud rings.
Billions of dollars are wasted each year on payments made as a
result of falsified medical claims.
Not only does
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Burn,
Burn, Burn |
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In
yet another creative business venture, a 61 year old former Binghampton, NY, realtor is on his way to prison
to
serve a ten year sentence. SUBSCRIBERS
ONLY
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Stupid Claimant Tricks |
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Fight Fraud America...
It's Already Working! |
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This issue's prize goes to Jerome Dobies, a Brecksville Ohio
resident...MORE |
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If
you haven't yet looked over the
FightFraudAmerica.com web site, do yourself a favor and get
familiar with it. We've already had some success stories, but the
latest one bears telling right now.
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this affect the property/casualty and health care insurance
industries, but it also exploits state and government health care
programs. For example, Federal authorities recently arrested
more than thirty suspects, including doctors and health care
business owners and operators across the nation, suspected in a
major Medicare fraud scheme. Their scams included giving patients
“arthritis kits,” which were nothing more than expensive orthotics,
such as knee or shoulder braces and heating pads, billed at $3,000 -
$4,000 each. Another recent Medicare fraud case involved a doctor in
Miami, FL, and two physician’s assistants billing the government
program for $10,903,509 worth of unnecessary HIV infusion
treatments. All three conspirators have been sentenced to prison
terms.
MORE
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Muslim 101
Part of the Cultural Diversity Series for Investigators |
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Imagine that there are five people sitting around a table in Anytown
USA.
MORE
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Burying the Dead...
Cultural
Beliefs |
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More often than not, bodies are buried in US cemeteries with the
head on the west end of the grave.
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Global Gotchas |
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1995 Archives
1996 Archives
1997 Archives
1998
Archives
(Subscription Required) |
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Antifreeze - The New Murder Weapon of
Choice |
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It
took jurors only three hours to convict Marguerite Bork of Second
degree murder. She's facing 25 years to life in prison when she get
sentenced in May, 2007.
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ONLY
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Just How Wide IS Workers' Compensation
Premium Fraud? |
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Six Million in Fake Policies =
Ten
Year Prison Sentence |
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A study in New York done by the Fiscal Policy
Institute reported that an estimted 15% of payroll had not been
reported to insurers. How many billions did that cost insurers ...
and the honest businesses that footed the bill when the costs were
passed on?
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An
Australian financial company rated insurance claim records against
zodiac signs, This may be a case of someone with way too much time
on his/her hands, but for what it's worth, here are the results:
Drivers, Worst to Best:
#1 Gemini
#2 Taurus
#3 Pisces
#4 Virgo
#5 Cancer
#6 Aquarius
#7 Aries
#8 Libra
#9 Leo
#10 Sagittarius
#11 Scorpio
#12 Capricorn |
What's an easy way to acquire interest in two buildings in San
Francisco, a condominium in Las Vegas and a
condominium in the Cayman Islands?
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ND Agent Suicide Prompts Investigation |
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Finally!!!! You Wanna Play Big, You
Gotta Pay Big |
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Mystery surrounds the largest fraud case to hit North Dakota in the
past 20 years. The only person who could have provided the answers
-- all of the answers -- was Diane Cottingham, owner of agencies in
Bismark, Washburn and Underwood. And she''s dead.
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Three cheers for the Seventh District Circuit Court, for doing
(04/04) an excellent job of imposing justice. Krishnaswami Sriram
admitted in Federal District Court that he had heavily defrauded the
Medicare program -- and the IRS for another $550,000.
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9
Doctors Charged with Medicare Fraud |
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The New Kid in
Town...
Gift Card Fraud |
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230x220 |
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Gift Card Fraud is the new kid in town. Plenty of towns, in fact.
One of the more recent cases was just popped by the Gainesville
Police Department (GPD, and resulted in the arrests of
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Imagine this scenario. Doctors, "cappers" and board-and-care
administrators cooperate to make elderly, infirm and mentally ill
patients available to get unnecessary respiratory therapy
treatments. Why?
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New York Family Affair |
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The Future of P&C SIU |
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The courtroom looks like the stage for a Houghtaling family reunion.
On trial are brothers Frank and Joseph Houghtaling, their twin
sister wives Renee and Rhonda Houghtaling, the mother Donna
Houghtaling, and her daughter, Brenda Warner.. The family is accused
of staging 23 crashes to collect insurance money.
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The year is 2017. The teleportation machine is still glowing as
we walk into the building that houses "The Futuristic Insurance
Company." Looking around we notice that data-mining technology
has made rapid advancement in the past ten years. Looking at
adjuster Tamara Tomorrow's
desk we see that when a claim is presented to a company, it is
instantly linked cross industry. The issued report not only
points out probable connections, but inter-company links are
utilized, records are automatically merged and files are tagged
for immediate report to overseeing agencies. Gone are the times
of multiple claims for a single incident. Tamara is relaxed and
smiling. MORE
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Video Surveillance Fraud? |
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The insurance industry is required to follow stringent rules when
filming claimants. There are restrictions on where you can film,
what sort of lenses you can use, what vantage point you choose ...
and all sorts of rules having to do with expectations of privacy.
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230x300 |
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230x220 |
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Site Design
by
Copyright 2007
JohnCooke.com
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Gap Insurance Fraud |
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Along with fluctuations in the overall economy, comes the
spawning of new forms of insurance fraud. Take, for
instance, Gap Insurance Fraud, a new scam perpetrated on
companies that emerged to fill a "gap" in the (primarily)
auto insurance marketplace.
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