False insurance claims, including health and auto insurance fraud, cost the average US family nearly $1,000 in increased premiums each year. These claims can be complete falsifications or exaggerations of real events, and are often filed in the healthcare industry. Providers may file complaints for treatments that were never provided or diagnose out-of-scope treatments. In the automotive industry, staged or exaggerated accidents are common.
Making false claims is a type of insurance fraud done with the intention of deceiving an insurance company. There are two main types of false claims: health insurance and auto insurance claim fraud. It is estimated that in the United States alone, bogus insurance claims cost the typical family nearly $1,000 US Dollars (USD) each year in increased premiums.
There are several ways a bogus insurance claim is typically filed. In most cases, the claim is a complete falsification of conditions or events. These deceptions may be entirely false or extreme exaggerations of real instances. Another common tactic is to use split billing, which is mostly done in the healthcare industry. A service provider will file a variety of complaints for different medical treatments when, in reality, the patient either did not receive all of the treatments or the treatments were not of the exact nature claimed by the provider.
The healthcare sector is the leading source of false insurance claims. These can be committed by the patient or the provider. When a patient attempts to make a false claim, you may refuse to disclose any pre-existing conditions in order to get care, or claim that a dependent is covered for care when in fact they are not. The person may also refuse to disclose any pre-existing conditions that might otherwise prohibit care or record inaccurate information on health insurance forms.
A supplier can also make false claims. The provider may file a complaint on behalf of a doctor who does not actually exist, bill for treatments that are more expensive than the patient actually received or treatments never provided, or diagnose and/or provide care for a treatment that is out of scope of the practice provider. Requests of this type sometimes result in suppliers being paid large sums of money under false pretenses.
The automotive industry is another major source of false insurance claims. There are two types of false claims that are typically filed within the industry: staged incidents and exaggerated incidents. In simulated accidents, claimants stage an elaborate setup in which they involve an innocent party, make the accident appear to be the other party’s fault, then proceed to get as much money as possible from the innocent person’s auto insurer. With exaggerated accidents, claimants claim that an accident was much worse than it actually was, resulting in higher degrees of car damage and/or personal injury.
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