Confronting Organized Insurance-Fraud Schemes and Sham Claims

Description

Insurance fraudsters now have advanced digital tools to make more difficult distinguishing the fraudulent claim from the valid one. Particularly concerning, perpetrators of fraud can now manipulate medical records, including x-rays and pet-scans, photographs and video, and metadata to produce convincing forgeries that are difficult to spot and prove.

Insurance fraud will usually focus on recovering high-value claims, such as from business interruption (data theft), jewelry theft, fire and water damage, inland marine, and other specialized property losses. But the “scams” are perennial: inventory swapping; submitting claims for injuries or damage that never occurred; staging accidents; forgery, involving unwitting third parties, and more.

To deter and thwart these increasingly complex and sophisticated deceptions that may cross multiple industries and involve different kinds of coverage, insurers and their counsel need practical, decisive, and effective weapons. At the same time, they must balance the need to avoid claims of bad faith, making false accusations, and comply with insurance regulations. How much information to provide prosecutors is always a challenging question. State immunity laws do not always cover allegations of insurance fraud.

Listen as the panel discusses proactive steps to identify fraud early on and then and prevent payment of the falsified claim, and if payment has occurred, how to judiciously but vigorously recover payment from the masterminds.