Insurance Fraud-Busting System Essay Example | Topics and Well Written Essays - 1000 words

Insurance Fraud-Busting System - Essay Example There are two case studies which were referenced within this current assignment. One is a case involving an insurance claim to replace a computer network, after a company experienced an unexpected energy surge. The second involved a woman who had unnecessary dental work, after an unethical dentist advised her that she needed filings. Both of these instances are, unfortunately, not uncommon these days. An additional insurance scam that I am familiar with is one involving chiropractors. A relatively healthy person will visit a chiropractor’s office and receive multiple chiropractic adjustments and massages. The patient, in many cases, will not pay any out-of-pocket costs for these services. Instead, the chiropractor will claim that the person has a problem and is in need of constant care. The office assistant will bill the insurance company for each visit made by the patient. The patient enjoys multiple massages and chiropractic adjustments for however many visits the health ins urance allows. The reason why this is a fraud is because it is expressly stated within the policy that a patient must have a legitimate medical condition and be in need of treatment, in order to receive benefits. This type of fraud is rampant as well. Still there are other insurance scams that many people are familiar with. Some people stage car accidents or leave their own keys in the car so that it will be stolen. Others fake an accident at work so that they can file a worker’s compensation claim and/or file for short/long-term disability. All false claims have a profit motive of some type. If the claim is not filed for actual cash, the purpose of the claim may be to replace a valuable damaged item. The attitude of Americans towards fraud is disheartening. On the Coalition Against Insurance Fraud website, there is a statistic cited from a survey conducted by Accenture Ltd, that â€Å"one of four Americans say it’s ok to defraud insurers† (Accenture, 2002). Ano ther study, cited on the same website by Progressive Insurance, stated that â€Å"Nearly one of 10 Americans would commit insurance fraud if they knew they could get away with it. Nearly three of 10 Americans (29 percent) wouldn't report insurance scams committed by someone they know† (NICB, 2011). This is a startling statement of American lack of morality. The proceeding information leads to a very important question. How do insurance companies combat fraud at the present time? Most insurance companies have an in-house Special Investigation Units (SIU). They normally seek to hire those with a law enforcement background for such positions. These groups are specifically tasked with attempting to uncover and investigate cases of fraud, specifically as it relates to claims filed through the insurance company. The group specifically will look for holes in a customer’s story. If there was an auto accident, for example, and both parties’ statements do not match, this can raise a red flag.