| A request for conducting insurance fraud | | | | practitioner had created or re-created the client |
| investigation is made for by either of the two | | | | service records to falsify the accounts, increase |
| parties to an insurance policy, viz. the consumer | | | | the number of visits made by the clients for |
| and the insurance company, when one of the two | | | | seeking consultations, thereby indulging in |
| parties feels that the other party has committed | | | | increasing the revenue per visit from the client, |
| a breach of contract, or the contractual obligations | | | | and indirectly increasing the market price of the |
| agreed to between the parties have not been | | | | client visits to the medical practitioners. |
| fully met. | | | | With regard to auto insurance fraud claims, the |
| There are a number of insurance schemes | | | | insurance fraud investigations are centered around |
| offered by the insurance companies to the | | | | the damage estimates and claims filed in the claim |
| consumers including medical insurance or health | | | | form. The insurance fraud investigations will then |
| insurance, automobile insurance, life insurance, crop | | | | be concentrated on the comparison of the claim |
| insurance and such other types of insurance. | | | | with similar claims in the past that were available |
| The opportunity for fraudulent activities in | | | | in-house in the investigator~{!/~}s office. The |
| insurance industry is more as the room for | | | | type of damages claimed for the vehicle and the |
| making quick money is more. For instance, in the | | | | amount charged for repairs for the vehicle, |
| US, it has been estimated that as much as $80 | | | | quoted by the auto mechanic, also offers valuable |
| billion is paid out every year towards fraudulent | | | | clues with regard to the damages, when |
| claims. | | | | compared with similar case histories from the |
| The role of insurance fraud investigations is crucial | | | | databank available at the investigations house. |
| in assessing the validity of the claim, discouraging | | | | The sophisticated methods employed by the |
| fraudulent claims and bringing the culprits to court, | | | | investigators in investigating frauds related to |
| and providing relief to the aggrieved parties. | | | | insurance frauds have resulted in decreasing the |
| The type of investigations being carried out for | | | | time lag between the lodging of the claim and the |
| each type of insurance varies in type and analysis. | | | | delivery of verdict. However, the prevalence of |
| In the case of medical health insurance frauds, | | | | insurance frauds in the industry, on the whole, has |
| insurance fraud investigations are carried out from | | | | been rampant, considering the lure of quick |
| the database to get hold of the medical history of | | | | money, which is available in the insurance industry. |
| the client~{!/~}s service history records. The | | | | It is advisable for both the consumers as well as |
| pattern of billing of the medical health practitioner | | | | the insurance companies offering policies to the |
| is examined in detail to find out for any anomaly | | | | consumers to act in accordance with the rules |
| in the billing. A detailed study of the service | | | | and regulations that are in vogue in the region, |
| records, in most of the cases in medical health | | | | and avoid insurance fraud investigations. |
| insurance fraud investigations, reveals that the | | | | |