The FBI reports that non-health insurance fraud costs U.S. citizens an estimated $40 billion every year, resulting in an increase of $400 to $500 in premiums for the average family. When a person or organization commits insurance fraud, this affects everyone who has insurance with that provider. Insurance companies have a difficult job of deciding whether an insurance claim is legitimate or not. Luckily, private investigators are experts in helping solve insurance fraud cases. Continue reading to discover how PIs help with insurance fraud investigations.
Types of Insurance Fraud
It’s no surprise that there are several types of insurance fraud. Whether it is from an organization or individual, it’s helpful to know what type of fraud you are dealing with. Let’s take a look below.
Healthcare Fraud
Healthcare fraud can occur when patients or healthcare providers submit a fake claim about an exaggerated or fake injury or illness that requires additional compensation. This is unfortunately common with Medicare and Medicaid as some people abuse their benefits designed to help those in need. An estimated 10 cents of every one dollar goes towards paying for fraudulent healthcare claims. Indeed, it makes sense that this is the most common type of insurance fraud.
Personal Injury Fraud
An individual may file a personal injury claim against another person or a business. This claim is fake when the person was injured due to their own negligence but pins the blame on someone else or a business. A good example is a person that falls and gets injured due to not paying attention to where they are walking, but stages the accident in front of a shopping center to receive compensation for the injury.
Property Damage and Theft Fraud
The type of property damage or theft claim can vary, such as water, fire, or flood damage or break-ins or burglaries. Since this type of claim can require thousands of dollars to fix, an insurance claims investigator may need to visit the home or business to look for proof of damage. This will also help determine the cause of the damage and whether it is eligible with the person’s insurance coverage.
Workers’ Compensation Fraud
Fraudulent workers’ compensation claims can significantly harm a business’s finances. To determine the validity of such a claim, an investigator can examine the incident. Through their investigation, they will find out:
- Did the employee become injured as they claim or is the injury exaggerated?
- Did the employee’s injury take place while they were working?
While most people are honest, some people will exaggerate or fake their work injuries. If a person claimed they were injured at work, but several sources reveal that they were injured at home over the previous weekend, this individual does not have a legit claim.
How Private Investigators Identify Fraud
Due to the continually rising issue of insurance fraud, private investigators are often hired to investigate potentially fraudulent claims. Both insurance companies and businesses hire PIs to help them crack down on those that are trying to cheat the system.
What Steps Do PIs Take to Find Fraud?
- They carefully examine insurance claims
- Perform surveillance when the suspect in question is in public places
- Conduct an investigation regarding the insurance claim
- Obtain and review all the evidence found
- Conduct a background check on the suspect
- Interview the suspect and relevant parties
PATRIOT Backgrounds and Investigations Can Help You
At PATRIOT Backgrounds and Investigations, we conduct fraud investigations to help our clients determine if a claim is legit or not. We conduct thorough research, surveillance, and interview witnesses, which is all combined into a detailed investigative report. This key evidence can be used in court as needed, which may be necessary for businesses, insurance providers, and even individuals. Instead of allowing someone to take advantage of you and cause you serious financial harm, it’s best to hire a professional PI to help you know whether an insurance claim is genuine. Contact the best private investigators in Davie, Florida today to learn more about our private investigation, background checks, and other services.
