2005 Insurance Fraud Statistics
- Received a total of 303 referrals
- 52 cases were sent to prosecution consideration
- 71 cases were closed due to insufficient evidence
- 65% of the referrals came from Douglas, Sarpy, and Lancaster Counties while the balance, 35%, were located in greater Nebraska.
- 82% of the IFPD referrals were property and casualty fraud.
- 11% of the IFPD referrals were life and health fraud.
- 7% of the IFPD referrals were internal and agent fraud.
- There was a total of more than $2.8 million dollars of actual and potential losses
| Fraud Category |
Insurance Type |
Cases |
Reported Losses |
| Total |
303 |
$2,859,561.51 |
|
|
|
Staged Auto Accidents
One type of staged accident involves "a vehicle that is positioned in front of an unsuspecting motorist and brakes suddenly, causing a rear-end crash". According to The National Insurance Crime Bureau, the top 10 cities with the highest numbers of staged auto accidents are the following:
- Miami, FL
- Los Angeles, CA
- Houston, TX
- Chicago, IL
- Philadelphia, PA
- Tampa, FL
- Cleveland, OH
- Orlando, FL
- New York, NY
- Boston, MA
Key State Laws Against Insurance Fraud
| State |
Insurance Fraud
Classified As
A Crime |
Immunity
Statutes |
Fraud
Bureau |
Mandatory
Insurer
Fraud Plan |
Mandatory
Auto
Photo
Inspection |
- (1) - Workers compensation insurance only.
- (2) - Healthcare insurance only.
- (3) - Arson only.
- (4) - Fraud bureau set up in the State Attorney General's office.
- (5) - Auto insurance only.
- (6) - Fraud bureau set up in the State Auditor's office.
- (7) - Fraud bureau set up in the state police office.
Source: Property Casualty Insurers Association of America; Coalition Against Insurance Fraud.
Republished with permission of the Insurance Information Institute.
|
|
Auto Insurance
Bodily Injury Claims:
In 2007, $4.8 billion to $6.8 billion were added in excess payments to auto injury claims.
Underwriting Fraud:
In 2006, auto insurers lost 10 percent of the $166 billion in personal auto premiums to premium rating errors.
Workers Compensation
In 2005 $489 million in worker compensation premiums, taxes and other expenses was being stolen due to the misclassification of New York construction workers.
In the U.S anti-fraud efforts have returned $6.17, or $260.3 million total in 2006-2007, for every $1 invested in workers compensation.
Consumer Attitudes
One out of five U.S adults thinks that it is acceptable to swindle insurance companies under certain conditions.
More Americans think that it is acceptable to misrepresent facts to lower the premium, down from 91% in 1997 to 82% in 2007.
Fewer than two out of five adult Americans have a positive opinion towards insurance companies.
Health Insurance
In the U.S, at least $68 billion on healthcare is lost to insurance fraud, annually.
Private Health Insurance
In 2007, there was an average of 363 open cases for each health insurer, while each insurer investigation unit processed an average of 791 cases over the course of the year.
Drug Diversion
Health insurers spend up to $72.5 billion a year on drug diversion.
Every year, private health insurers suffer $24.9 billion in losses due to drug diversion.
Whistleblower Lawsuits
There was a total of $13.2 billion in civil settlements from 3,665 cases from 1987 to 2007.
Medicare Fraud
An estimated amount of $60 billion or more was lost to Medicare and Medicaid fraud.
$10 in fraud would be stopped for every $1 spent on Medicare Fraud prevention.
29% of Medicare claims for durable medical equipment were fraudulent.
Up to $16 billion paid by Medicare and private health insurers annually for redundant doctor examinations.
Medicaid Fraud
In 2007, there were a total of 1,205 convictions from 50 states Medicaid fraud control units, and a total recovery of more than $1.1 billion.
At least 61% of medical providers, which were banned from state Medicaid in 2004 and 2005, did not enter the federal database.
FBI Enforcement
In 2007, out of 2,493 health-fraud cases being investigated, there were 839 indictments and 635 convictions being conducted
In 2007, there were court-ordered compensation of $1.12 billion, recoveries of $4.4 million, fines of $34 million, and a total of $61.2 million in 308 seizures
Medical Identity Theft
3% of 8.3 million victims of identity theft fall under the category of medical identity theft
40% of 18-49 year-old Americans as well as 57% of Americans aged 50 and above have their insurance or Medicare card but with their spouse’s ID number
Works Cited
- Insurance Fraud Prevention Division. (2009). Retrieved January 10, 2009, from Nebraska Department of Insurance: http://www.doi.ne.gov/fraud/ifpdindex.htm
- Insurance Information Institution. (2007). Retrieved January 11, 2009, from Insurance Fraud: http://www.iii.org/media/hottopics/insurance/fraud/
- Go Figure: Fraud Data. (2009). Retrieved January 10, 2009, from Coalition Against Insurance Fraud: http://www.insurancefraud.org/stats.htm
