تازه ترین گزارشات سازمان جهانی بهداشت نشان می دهد که موارد مبتلا به آنفلوآنزای A/H1N1 در 33 کشور به حدود 6 هزار و 500 مورد و 65 مورد مرگ رسید.به گزارش خبرگزاری مهر، این اطلاعات تائید می کنند که تاکنون 6 هزار و 497 مورد ابتلا به این بیماری و 65 مورد مرگ در 33 کشور به ثبت رسیده است.در آمریکا این آمار به سه هزار و 352 مورد شیوع و سه مورد مرگ و در مکزیک به دو هزار و 446 مورد بیماری و 60 مورد مرگ اشاره می کند.براساس گزارش رویترز، در کانادا نیز 389 مورد به این ویروس آلوده شده اند و یک نفر نیز جان خود را از دست داده است.همچنین یک مورد مرگ در کاستاریکا تائید شده است. در این کشور هشت مورد بیمار شده اند.جدول شیوع بیماری در33 کشور آلوده به ویروس آنفلوآنزای خوکی به شرح زیر است:1- آمریکا: سه هزار و 352 مورد بیماری- سه مورد مرگ2- مکزیک: دو هزار و 446 مورد بیماری- 60 مورد مرگ3- کانادا: 389 مورد بیماری- یک مورد مرگ4- کاستاریکا: هشت مورد بیماری- یک مورد مرگ5- آرژانتین: یک مورد6- استرالیا: یک مورد7- اتریش: یک مورد 8- برزیل: هشت مورد9- چین: چهار مورد10- کلمبیا: هفت مورد11- کوبا: یک مورد12- دانمارک: یک مورد13: السالوادور: چهار مورد14- فنلاند: دو مورد15- فرانسه: 14 مورد16- آلمان: 12 مورد17- گواتمالا: سه مورد18- ایرلند: یک مورد19- فلسطین: هفت مورد 20- ایتالیا: 9 مورد21- ژاپن: چهار مورد 22- هلند: سه مورد23- نیوزلند: هفت مورد24- نروژ: دو مورد25- پاناما: 29 مورد26- لهستان: یک مورد27: پرتغال: یک مورد28- کره: سه مورد29- اسپانیا: 100 مورد30- سوئد: دو مورد31- سوئیس: یک مورد32- تایلند: دو مورد33- انگلیس: 71 مورد
۱۳۸۸ خرداد ۳, یکشنبه
10 فرمان برای پير شدن !
شايد اولين راه براى جوانتر شدن به نظر بيشتر افراد جراحى پلاستيک باشد. اما اين گزينه هميشه بهترين راه نيست، شما مى توانيد با تصحيح روحياتى که صرفا سن شما را بالا مى برند و به سلامتتان نيز آسيب وارد مى سازند، بدون جراحي، زمان را به عقب باز گردانيد. در اين قسمت 10 نمونه از رفتار ناسالمى که باعث بالا رفتن سن مى شود را ذکر کرده ايم. در ادامه راه حل هاى ترک و مبارزه با آنها را نيز بررسى نموده ايم. استرس بيش از اندازه از زمان غارنشين ها به بعد، رفته رفته استرس در انسان ها افزايش پيدا کرد. همانطور که مطلع هستيد استرس، واکنش سيستم ايمنى بدن را کاهش مى دهد، ريسک ابتلا به بيمارى هاى قلبى را افزايش داده و به طور کلى احساس نا خوشايندى در ما ايجاد مى کند. دکتر "اليسا اپل" استاد روانپزشکى دانشگاه کاليفرنيا واقع در سانفرانسيسکو ثابت کرده است که استرس بيش از اندازه برروى تک تک سلول ها تاثير سوء مى گذارد و باعث مى شود پيش از اينکه سلول ها به رشد کامل برسند، پير شوند. اين امر تا حد بسيار زيادى سيستم ايمنى بدن را مورد حمله قرار داده و منجر به تضعيف آن مى شود. به عنوان مثال مادرانى که فزرندانشان به نحوى دچار بيمارى هستند، تحت فشار بيش از حدى قرار مى گيرند. پيرى زودرس يک مشخصه کاملا بديهى در اين دست افراد مى باشد. راه حل چيست؟ دکتر اپل اظهار مى دارد که : "پيش از هر چيز بايد اين مشکل را قبول کنيد و علائم آنرا با خود تحليل و بررسى نماييد. تپش قلب، و تعرق از نمونه هاى بارز اين بيمارى هستند. يک راه حل آنى و مفيد نفس عميق است. از نظر پزشکى اين نوع نفس، "تنفس ديافراگمي" ناميده مى شود. اما راه حل مشکل تر و زمان بر اين است که در برنامه خود وقتى را به انجام کارهايى اختصاص دهيد که استرس شما را کاهش مى دهند. مصرف الکل شکى وجود ندارد که مصرف الکل ارتباط مستقيمى با افزايش استرس دارد. سعى کنيد از مصرف الکل خوددارى کنيد. در غير اينصورت ريسک ابتلا به بيمارى هايى نظير سکته، سرطان کليه، حنجره و سينه در فرد افزايش پيدا مى کند. تحرک بسيار کمدکتر "ويليلام جى ايوان" استاد تغذيه، پيرى زودرس، و فيزويولوژى در دانشگاه علوم پزشکى آرکانزاس معتقد است که: "کم تحرکى يکى از مشکلاتى است که بيشتر انسان ها به آن مبتلا هستند. حتى افزايش ميزان کمى فعاليت مى تواند عمر شما را طولانى تر کند، از اضافه وزنى جلوگيرى مى کند، استرس ا کاهش داده و در برخى موارد از ابتلا به آلزايمر نيز جلوگيرى مى کند. دکتر ايوان در ادامه سخنان خود اظهار مى دارد که : "فقط بايد تصميم بگيريد که کمى فعال تر از گذشته باشيد. مى توانيد ماشين خود را کمى دور تر از محل کار پارک کنيد و به جاى استفاده از آسانسور از راه پله بالا رويد. زمانى که به انجام اين کارها عادت کرديد، آنگاه مى توانيد نرمش و ورزش را شروع کنيد و طبق دستور سازمان کنترل بيمارى هاى فراگير برنامه خود را دنبال کنيد. اين سازمان به تمام افراد پيشنهاد مى کند تا درحدود 30 دقيقه (و يا بيشتر) در طول روز پياده روى کند. مصرف بيش از اندازه چربى هاى اشباع شده چربى هاى اشباع شده که در گوشت قرمز، گوشت مرغ، شير، و کره به وفور يافت مى شوند مى توانند ميزان کلسترول "بد" و به طور کلى کلسترول نهايى خون را افزايش داده و شما را مستقيما به سمت بيمارى هاى قلبى هدايت کنند. از رژيم هاى غذايى تک اشباعى نظير روغن زيتون، و بادام زميني؛ و همچنين انواع غير اشباع شده آن مانند روغن هاى گياهى و ذرت استفاده کنيد. دکتر ايوان اينطور مى گويد که " هر چند با استفاده از رژيم و شيوه غذاى مديترانه اى ممکن است وزن شما کاهش پيدا نکند، اما حداقل سلامت بدن تضمين خواهد شد." بر طبق دستورالعمل هاى غذايى که از سوى سازمان تغذيه امريکا منتشر شده است، افراد بايد ميزان مصرف چربى هاى اشباع شده خود در طول يک روز را به رقمى در حدود 10 در صد و يا پايين تر از آن برسانند. سيگار کشيدن بيش از 5/1 درصد بزرگسالان آمريکا که برابر با 46 ميليون نفر مى شود، هنوز به استعمال سيگار عادت دارند. به جاى کشيدن سيگار مى توانيد از قرص هاى نيکوتين دار که امروه به عنوان جابگزين مناسبى براى سيگار به شمار مى روند، استفاده کنيد، با اين کار ريسک ابتلا به سرطان و پيرى زودرس را تا حد بسيار زيادى کاهش داده ايد. در بررسى 123 مطالعه مختلف که در سال 2004 منتشر شد، افرادى که براى ترک سيگار از آدامس هاى نيکوتين دار و ساير جايگزين ها استفاده مى کردند، خيلى راحت تر از افرادى که فقط با اتکا به اراده، قصد ترک سيگار را داشتند، موفق شدند. تنفس هواى آلوده تنفس هواى آلوده منجر به سرفه، سوزش چشم ها، آسم و ساير بيمارى هاى تنفسى مى شود. گفتنش آسان است؛ اما سعى کنيد تا جايى که امکان دارد در روزهايى که آلودگى هوا بالاى حد هشدار دهنده مى رسد، از خانه خارج نشويد. قرار گرفتن بيش از اندازه در نور خورشيد هر ساله بيش از يک ميليون آمريکايى متوجه مى شوند که مبتلا به سرطان پوست شده اند. در حدود 55000 نفر نيز مبتلا به حادترين حالت اين بيمارى يعنى همان "ملانوما" شده و به کام مرگ فرو مى روند. مى بايست تا آنجايى که مى توانيد از قرار گرفتن در زير نور مستقيم آفتاب پرهيز کنيد و از کرم هاى ضد آفتابى با درجه مقاومت حداقل 15 استفاده کنيد. با اين کار هم از ابتلا به سرطان پوست جلوگرى مى کنيد و هم بروز چين و چروک پوست. کم خوابى در زمان هاى قديم کم خوابى نوعى علامت افتخار به شمار مى رفت، اما امروزه همه مى دانند که کمبود خواب سبب بروز چاقي، ديابت، فشار خون، و مشکلات حافظه مى شود. اين علائم حتى در جوانان و نوجوانان نيز قابل مشاهده است. "رونالد کلاتس" رييس آکادمى داروى هاى ضد پيرى شيکاگو معتقد است که: " اتاق خواب خود را پاک سازى کنيد تا تبديل به بهترين مکان براى خوابيدن شود، تلويزيون و ساير وسايلى که به نحوى حواس شما را پرت مى کنند، از آنجا دور نگه داريد. از پرده هايى استفاده کنيد که اندکى تيره تر هستند تا نور اتاق کم شده و تاريک تر شود. اضافه وزن چاقى بيش از اندازه خطر بيمارى هاى قلبي، ديابت، و حتى سرطان را افزايش مى دهد. اين امر در حالى است که64 در صد از آمريکايى ها دچار اضافه وزن هستند. محققان معتقدند که توانايى در حفظ رژيم غذايي، خيلى مهمتر از نوع رژيم است. دانشمندان چندين رژيم غذايى مختلف را مورد بررسى قرار دارند و نتيجه تحقيقات خود را در ژورنال سازمان تغذيه آمريکا به چاپ رساندند. پژوهش هاى آنها حاکى از اين امر بود که در ميان افرادى که رژيم گرفته بودند آنهايى موفق به کاهش وزن شدند که بيشترين زمان ممکن، رژيم را رعايت کرده بودند. بنابراين رمز موفقيت اين است که: رژيمى انتخاب کنيد که مطابق با شيوه زندگيتان بوده و احتمال حفظ آن بيشتر باشد. مصرف شکر فراوان مصرف شکر به طور بى رويه، باعث بروز چاقى و احتمالا بيمارى هاى قلبى مى شود. متخصصان تغذيه پيشنهاد مى کنند در يک رژيم غذايى 2200 کالري، مى بايست ميزان مصرف " افزودنى هاى شيرين" که در اسنک ها و شيرينيجات به وفور يافت مى شود، به 12 قاشق چايخورى در طول روز کاهش پيدا کند. بر طبق اطلاعات دپارتمان کشاورزى امريکا در سال 2000 مصرف اين ماده در حدود 31 قاشق در روز براى هر فرد تخمين زده شده است. براى کاهش اين مقدار بايد از ميوه ها، و سبزيجات شيرين استفاده کنيد تا ميل شما به شيرينى نيز کاهش پيدا کند. برچسب روى محصولات مختلف غذايى را به دقت بررسى کنيد تا ميزان شکر مصرفى را به حداقل برسانيد.
Insurance fraud has existed ever since the first insurance company was opened. Types of insurance fraud comes in different shapes and sizes and occurs in all areas of insurance and the severity of crimes range from slightly exaggerating claims to deliberately causing accidents or damage. Insurance fraud ultimately harms society as it causes the premiums to increase to make up for the money lost in a fraudulent way. Governments and other organizations are making many preventative efforts to stop the ever-increasing insurance fraud. Besides a few special cases when the federal government gets involved in insurance fraud after it has happened, most of recuperating lost funds from fraudulence lies on the company. This is when a professional insurance fraud investigator, such as Brooks Brothers Investigations, can come in handy.
When Brooks Brothers Investigations gets on the trail of the unlucky one committing insurance fraud, they come equipped for the special occasion. The investigator is equipped with a multitude of covert hidden cameras, night vision, GPS systems and camouflage clothes. BBI will go to the extreme to find your deceiving claimant which will ultimately safeguard your money. Your money has been made through hard work and it should not be freely handed to thieves. It would also be nice to send the message out: We will not tolerate insurance fraud.
Insurance Fraud is not committed by hard criminals. In fact insurance fraud is committed by people who are, for the most part, honest. Their attitude is of this nature: "It's only a few dollars. Insurance companies have lots of money, anyway!" They forget to look into the truth. Many insurance companies are down-sizing because they are losing more money than they should. The insurance business is an ever-changing business that needs money to advance their systems to achieve everything from processing a claim quicker to hiring more workers to better computers to additions to their building or possibly even new construction in which to place the business. BBI can help you achieve these goals by cracking down on the ones stealing from your business. Hire BBI and put a stop to insurance fraud. Here at BBI we believe it would be in your best interest.
We have no problem doing what it takes—without violating laws, preserving your integrity and our integrity and our overall relationship—to find your information. An example of this would be confidentially talking to the claimant's neighbors to find information on the claimant's physical activities. We have found this to be a good source of information as neighbors often see each other's activities. We will record and do a surveillance on the claimant's property. We might find that the roof is being remolded; we might find intensive-labor yard work—which are all signs that the claimant is not only using the money that you're giving him or her but using the healthy body that is supposed to be injured from an accident. We record activity such as this and load the video footage straight into your on-line BBI account from the field. You will able to watch the event unfold just moments after it has happened right from your screen at the workplace.
BBI is the leading insurance fraud investigator, using the latest techniques and equipment and investigative knowledge in the insurance business. BBI works hard for corporations, insurance defense firms and insurers. Please contact BBI to find out how BBI can help your company in exposing insurance fraud and overall assist in recuperating insurance fraud funds.
BBI has Many Investigative Services to Offer
Brooks Brothers Investigations offers many investigative services. These services use information gathered from our advanced database search engines, full access to public records, interviews, documentation and/or recorded statements. We will give you a complete claimant profile which will satisfy your investigative inquiry.
BBI will Document Claimant Activities This is a great service offered as looking into claimant activities will help to determine if more investigation is needed, such as surveillance. Whatever the request, BBI will uncover the information for you. We look into claimant activities such as checking to see if the claimant activities are in opposition to the injury purported in the claim. We check into the situation by looking to see the claimant's monetary status. The claimant may simply be hard-up for cash. The claimant that has purported to have serious back injuries may be caught helping a friend move furniture, playing softball at the local softball fields, or lifting with ease heavy boxes over 100 pounds. We have found that the claimant that purports false insurance claims does not, at every minute of the day, fake the injury. A claimant may forget to act or simply get fatigued of acting. And in these moments, while the claimant is under heavy surveillance, we will catch the claimant in the act.
Recording Words Spoken During Interview/Irrefutable Evidence Having evidence, or documentation, is extremely important to the case file. BBI records the words spoken during the interview that is being conducted in person or by phone. Recording what is spoken during an interview is much more effective than writing it down. At BBI we are not satisfied with just finding evidence. We are not satisfied until we find hard evidence; it's not about the evidence; it's about the irrefutable evidence.
Various Services BBI Offers• Scene of Accident Investigation & Documentation (we will review all reports of the accident) • Medical Investigations• Hospital Investigations• Casualty Interviews (liability, disability and workman's compensation)• Pharmacy Investigations• Chiropractic Investigations• Dental Investigations
Checking Our Database Search Engines • Real Property Search (we search both state & Nationwide)• Motor Vehicle Registration Search• Person Profile Search (state & Nationwide) • Check State Driver's History • Motor Vehicle Registration Search• Skip Tracing (locate a person (state & nationwide)
Free Conferences & Seminars from BBI BBI offers free investigations information seminars to corporations, firms, or any company interested in learning how BBI can be of assistance. BBI will give free information on up-to-date technology, current investigative techniques, and much more. If you are not a current client the seminar would be a very effective way to learn about the services that BBI can offer your company. If already a client BBI will keep the company updated on the services it provides. Please feel free to take advantage of this great opportunity!
Claims InvestigationsBBI will do a claim investigation. We will gather evidence that will give claims representatives what they need in order to determine the compensability of a claim. We will meet with the claims representative before doing our investigation. As soon as we are thoroughly briefed on the situation we will go into the field and find your evidence. We also look forward to sharing information with the company representatives on how we can assist in claim investigations. An example of what we might share is information on preventing fraudulent claims. Below is an example displaying the services we provide in a claim investigation:• Arson • Liability • Auto Theft • AOE-COE• Injury • Auto Liability • Suspicious Death • Background Checks
Car Insurance Fraud and You: How to Avoid Getting Ripped Off (Be the first to respondEnter your search terms Submit search form
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Car Insurance Fraud and You: How to Avoid Getting Ripped Off (Be the first to respond)
Sadly, insurance fraud does exist. No one wants to be a victim, but it happens. There are however, ways you can sharpen your instincts and avoid being taken advantage of. Here are some tips on strengthening your common sense in order to avoid scammers.
Shop around.
It really does pay to comparison shop. Not only should you visit the websites of well-known insurance providers, you should also visit your state’s car insurance department website. Dig deep and find out as much information as possible before making a final decision. Be sure to check out websites for A.M. Best, Standard & Poor’s and J.D. Power and Associates when it comes to shopping around. These websites offer information about a company’s financial stability as well as ratings given by nationwide policyholders.
Make sure your agent or broker is legit.
Never, work with an unlicensed agent or broker. Make sure they have the proper credentials. Ask to see them. Don’t be shy about it. In all reality, it is your responsibility to do so. If the agent or broker seems hesitant about verifying their license, run fast in the other direction. If you don’t have the confidence to ask them in person, you can call the your state’s Insurance Department’s Licensing Bureau.
Stay aware of premium rates.
Your premiums are based on you as an individual (i.e. your personal claims and degree of risk). If you drive a clunker and are asked to pay rates that a driver of a newer car would pay, walk away. No reputable company will have you pay outrageous rates unless you have a history of being a high-risk driver.
Have the proof handy.
First of all, never pay for your insurance premium in cash. Always pay by check or money order. If you pay online, be sure to print out the confirmation. Proof of payment is absolutely necessary if you’re faced with insurance fraud.
Get a copy of your policy.
This should be an automatic step when dealing with a personal agent or insurance company. Your policy copy should outline your entire coverage, including your limitations.
Follow up.
If you’ve been involved in an auto accident, always make sure that the police document the incident. In some cases however, a mild fender-bender can be taken care of by swapping insurance information with the other driver. With this said, if the other driver is hesitant about giving over their insurance information, consider it cause for alarm. They may have fraudulent coverage or, even worse, may not be covered at all. In cases like these, it is always best to have the authorities drive out to the accident scene.Now that you’re aware of the ways you can have a head’s up on auto insurance fraud, it’s time to look at the three main types of scams.
Inflated claims.
If your claim seems to be more expensive than you think it should be, look it over. Make sure you have documentation from the accident and compare it with the claim. Unfortunately, some auto body shops raise the rates on accident victims and then pocket the extra money for other reasons.
Staged accidents.
Yes, it’s true. There are actually people out there so desperate to make a buck that they’d stage an accident. How does it work? You’re driving down the road and all of a sudden the car in front of you (usually filled with passengers) comes to a sudden stop, causing a rear-end collision. Next thing you know, these so-called victims are filing for medical and damage claims. What’s even worse is that the doctors and lawyers they use are involved in the scam as well.If this happens to you, take extra precaution and document everything. Try hard to find eyewitnesses. If no one is around, call for police assistance. If something seems off, then follow your gut.
Steerers.
These people steer injured parties to doctors and lawyers who are all part of their scam. With this “direction,” comes a referral fee. A what? Yes, a referral fee. Don’t do it. If you do, you can pretty much consider yourself a victim of fraud.While these aren’t the only types of scams out there, they are the most popular. If you find yourself a victim of auto insurance fraud or have questions about insurance fraud, contact your state’s Department of Consumer Services Bureau.
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Insurance Fraud
If you have been arrested for Insurance Fraud in Florida, it is important that you hire an experienced Insurance Fraud criminal defense Attorney to represent you. The Law Offices of William H. Bryan III, P.A. will work tirelessly to attempt a successful defense to the crimes with which you have been charged. As a former Assistant United States Attorney for nearly 10 years, William H. Bryan III understands how to aggressively defend Insurance Fraud crimes in the state of Florida. We are a strong believer of our clients' Consitutional rights and will do everything in our power to protect them. William H. Bryan III is an aggressive Orlando Insurance Fraud criminal defense lawyer who will handle every aspect of your criminal case up to and including trial.Insurance Fraud Insurance fraud/false insurance claims are insurance claims filed with the intent to fraud insurance provider companies.Insurance fraud hurts the average person in two ways. First, all fraud costs, including losses, investigations, etc. arerecovered by the insured people through higher premiums, or, in the case of government insurance by higher taxes. Second, if a particular individual is the target for the fraud, they have costs such as deductible payments, loss of property use, etc, as well as higher premiums from the claim loss and the potential for denial of future coverage.Insurance claims filed with the intent to defraud an insurance provider is known as Insurance fraud. In the United States insurance fraud estimated-ly cost US$875 per person annually but with The Coalition Against Insurance Fraud working, it decreases each year loss to estimate $80 billion per year.Health insurance fraud is defined as an intentional act of deceiving or misrepresenting information that results in health care benefits being paid to an individual or group. Studies prove that over 30 billion dollars get lost annually to health care fraud in the United States. In order to control costs, insurance companies investigate fraud for the benefits of their members.Fraud can be committed by both a member and a provider. Member fraud consists of members not eligible, alterations on enrollment forms, prescription drug fraud, etc. Provider fraud consists of claims submitted by fake/bogus physicians, billing for services not provided, for higher level of services, diagnosis or treatments that are outside the scope of practice, and providing services while the license have been revoked.In response to the increased amount of health care fraud in the United States, Congress has passed a Health Insurance Portability & Accountability Act of 1996 ,which has established health care fraud as a federal criminal offense with punishment of up to 10 years of prison in addition to significant financial penaltiesWhy we are good law firm for your problems?With more than 20-years of experience representing insurers in fraud matters, our Attorneys have the necessary knowledge and skills to advise on a wide range of litigation, counseling and legislative matters. We provide clients with a blend of experience in government, law enforcement and private practice that well serves their needs in this complex and critical area. Our Attorneys not only have extensive experience in the representation of insurers in fraud-related litigation, but also have in- depth substantive knowledge in many of the areas where insurers need expert advice. We believe that getting control of the facts is the best game plan for success. Unlike other law firms, we have the staff and the experience to deliver on this vision. Choosing an Orlando Insurance Fraud lawyer is an important decision. Your freedom is at stake. You should carefully research the Attorney and/or law firm who will represent you before before making any decisions. At the Law Offices of William H. Bryan III, P.A., we have broad experience in all kinds types federal felonies offenses, from pre-arrest investigation through trial. No Insurance Fraud case is too big or too small for our firm to handle. We treat every Insurance Fraud case with same devotion and attention, regardless of the charges and potential penalties involved. We understand the criminal laws as they relate to Florida Criminal Defense and we are devoted to providing effective legal representation to our clients in all manner of criminal proceedings. We are an aggressive criminal defense firm operating in Orlando, Florida and surrounding metropolitan areas.
insurance fraud
Go figure: fraud data
Measuring insurance fraud is an elusive target. No single national agency gathers omnibus fraud statistics. Insurance fraud data thus are relatively piecemeal, making our understanding of insurance fraud an ongoing work in progress.
Insurance companies and diverse state and federal agencies each gather fraud data related to their own missions. But the kind, quality and volume of data they compile vary widely.
Independent watchdogs, academics, insurance industry groups and other organizations also conduct research on a variety of fraud topics. Some is national in scope, and some is state-specific.
State insurance fraud bureaus
Fraud bureaus are state agencies charged with investigating suspected insurance schemes within their states. Most states have fraud bureaus, which investigate suspected schemes across most line of insurance. States without multi-line fraud bureaus include: Alabama, Illinois, Indiana, Maine, Michigan, Oregon, Vermont, Wisconsin and Wyoming.
The 2007 annual study of state fraud bureaus by the Coalition Against Insurance Fraud reveals this 2007 combined profile.
Budget
$147,738,214
Employees
1,694
Referrals
115,062
Cases opened
31,654
Arrests
4,848
Presentations to prosecutors
5,936
Convictions
4,228
Civil actions
7,672
Restitution ordered
$179,036,100
Cases reported by the news media so far in 2009.
By type of fraud
Auto insurance
Auto bodily injury claims: Staged-accident rings fleece auto insurers out of billions of dollars a year by billing for unnecessary treatment of phantom injuries. Usually these are bogus soft-tissue injuries such as sore backs or whiplash, which are difficult to medically dispute.
Fraudulent and abusive auto-injury claims are a costly problem. Fraud and “buildup”* added $4.8 billion to $6.8 billion in excess payments to auto injury claims in 2007. That means 13-percent to 18-percent increases in payments under private-passenger auto policies from 2002. (Insurance Research Council, Nov. 2008)
Bogus and abusive claims also are rising. They ranged between $4.3 billion and 5.8 billion in 2002, or between 11 percent and15 percent of total payments. (ibid)
Claims with apparent fraud or buildup were more likely than other claims to involve sprain and strain injuries, and periods of disability. These claimants also were more likely to receive treatment from physical therapists, chiropractors and other alternative medical providers. (ibid) Buildup involves treatment that’s excessive but isn’t deliberately or criminally fraudulent.
Underwriting fraud : Dishonest drivers try to lower auto premiums by dishonestly lying on their insurance application or renewal. Among the ruses: registering their vehicles in locales where premiums are lower; low-balling their stated mileage; and saying a commercial vehicle is used mainly for personal use.
Auto insurers lost $16.1 billion due to premium rating errors in private-passenger premiums in 2007. Premium rating errors account for 10 percent of the $166 billion in personal auto premiums. Fraud accounts for a portion of these losses. Some drivers will seek to lower their premiums by schemes such as deliberately misrepresenting mileage driven, how the vehicle is used and where it’s registered. (Quality Planning Corporation, 2008)
Workers compensation
Some businesses illegally try to avoid paying full state-required workers compensation premiums. One scheme involves paying workers off the books because the number of employees is a factor in determining a business’s premiums. Another scheme involves misclassifying employees in high-risk jobs as holding lower-risk jobs.
At least 50,000 construction workers in New York City — one of four —are paid off the books or misclassified as independent contractors. (Fiscal Policy Institute, 2007)
Those schemes stole $489 million in workers compensation premiums, taxes and other expenses in 2005. That figure could reach $557 million in 2008. (ibid)
More than 39,500 employers misclassify 704,785 workers — or 10.3 percent of the workforce — throughout New York State each year. (Linda H. Donahue, James Ryan Lamare, and Fred B. Kotler,Cornell University, 2007)
In construction, 45,474 workers — or 14.8 percent of New York’s workforce — are misclassified as independent contractors. (ibid)
Employers in high-risk California industries may hide up to 75 percent of their payroll — or $100 billion — for the most-dangerous jobs. This forces honest employers to pay workers comp premiums as much as eight times higher than if everyone paid their fair share. (Frank Neuhauser and Colleen Donovan, University of California-Berkeley, 2007)
Every $1 invested in workers compensation anti-fraud efforts has returned $6.17, or $260.3 million total in 2006-2007. (California Insurance Department, 2007 annual report)
Workers comp insurers in Massachusetts lose $100 million a year in unpaid premiums to businesses that illegally pay workers cash under the table or falsely label employees as independent contractors. (Social and Economic Costs of Employee Misclassification in Construction, Harvard University, December 2004)
As many as one of seven construction workers in Massachusetts is hired off the books or illegally classified as independent workers. (ibid)
Consumer attitudes
Consumer tolerance of insurance fraud remains relatively high, public-opinion polls have consistently shown in recent years. The coalition’s study is the newest national research into what people think about this crime.
One of five U.S. adults — about 45 million people — say it’s acceptable to defraud insurance companies under certain circumstances. Four of five adults think insurance fraud is unethical. (Four Faces of Insurance Fraud, Coalition Against Insurance Fraud, 2008)
Nearly one of four Americans says it’s ok to defraud insurers (8 percent say it’s “quite acceptable” to bilk insurers, and 16 percent say it’s “somewhat acceptable.”) (Accenture Ltd., 2003)
About one in 10 people agree it’s ok to submit claims for items that aren’t lost or damaged, or for personal injuries that didn’t occur. Two of five people are “not very likely” or “not likely at all” to report someone who defrauded an insurer. (ibid)
Consumer tolerance of specific insurance schemes has increased over the last 10 years, reveals the Four Faces study. There is a decline in the number of Americans who think it’s unethical to:
misrepresent facts on an insurance application to lower their premiums (82 percent today, down from 91 percent in 1997);
file a claim for damage that occurred before the damage was covered (85 percent, down from 91 percent);
inflate a claim to cover the deductible (84 percent, down from 91 percent); and
misrepresent an incident in order to be paid for an uncovered loss (84 percent, down from 92 percent).
Consumer attitudes toward insurance providers also have declined over the last 10 years, according to Four Faces:
62 percent of people have a positive attitude about insurance companies (down from 72 percent in 1997); and
Fewer than two of five adults feel positively about the insurance industry as a whole (down from slightly more than 50 percent).
Health insurance
In general
The U.S. spends more than $2 trillion on healthcare annually. At least 3 percent of that spending — or $68 billion — is lost to fraud each year. (National Health Care Anti-Fraud Association, 2008)
Private health insurance
Every $2 million invested in fighting health-care fraud returns $17.3 million in recoveries, court-ordered judgments, plus bogus claims that weren’t paid and other anti-fraud savings. (National Health Care Anti-Fraud Association, 2008)
The average health insurer’s anti-fraud investigative unit has an annual budget of slightly more than $1.9 million and 19 fulltime employees. (ibid)
The average health insurer has 363 open cases in 2007, and each insurer investigation unit handled an average of 791 cases total for 2007. (ibid)
More than seven of 10 insurer investigative units use fraud-detection software. (ibid)
Drug diversion
Insurance fraud is a major financier of America’s epidemic diversion of addictive prescription drugs such as OxyContin, according to Prescription for Peril, a December 2007 report by the Coalition Against Insurance Fraud.
Drug diversion costs health insurers up to $72.5 billion a year in bogus claims involving opioid abuse alone;
Private health insurers lose up to $24.9 billion annually;
Diversion costs individual private insurance plans up to $857 million annually;
Nearly half of Aetna’s member/pharmacy anti-fraud team’s caseload involved prescription benefits in 2006;
Expenses of suspected doctor-shopping members of Medco Health Solutions were nearly seven times higher than the monthly cost of members without excessive prescription claims; and
Abuse suspects incurred $41 in claims for office visits and outpatient treatment for every $1 in narcotic prescription claims against WellPoint.
Whistleblower Lawsuits
The federal False Claims Act allows whistleblowers to obtain a portion of any federal civil recoveries stemming from the whistleblower’s efforts to expose fraud against programs. Whistleblowers account for a major portion of healthcare convictions because they tend to be insiders at the offending healthcare organizations, and thus have unique access to information needed to charge and convict.
$1.55 billion in civil settlements and judgments from 218 cases in 2007 in which the Department of Health and Human Service was the primary client agency. (U.S. Department of Justice)
$13.2 billion in total civil settlements from 3,665 cases from 1987 through 2007. (ibid)
Whistleblowers received an average of 16.84 percent of recoveries when the federal government intervened. (Taxpayers Against Insurance Fraud, 2008)
The federal government recovers $15 for every $1 invested in False Claims Act health-care investigations and prosecutions. (Taxpayers Against Fraud, 2008)
Medicare Fraud
Medicare’s annual anti-fraud budget is $465 billion. (Miami Herald, August 11, 2008)
Medicare and Medicaid made an estimated $23.7 billion in improper payments in 2007. These included $10.8 billion for Medicare and $12.9 billion for Medicaid. Medicare’s fee-for-service reduced its error rate from 4.4 percent to 3.9 percent. (U.S. Office of Management and Budget, 2008)
Medicare and Medicaid lose an estimated $60 billion or more annually to fraud, including $2.5 billion in South Florida. (Miami Herald, August 11, 2008)
Every $1 spent on Medicare fraud prevention would stop $10 in fraud. (U.S.Department of Health and Human Services) (Miami Herald)
Medicare spends less than 0.2 cents of every $1 of its $456 billion annual budget combating fraud, waste and abuse. (Miami Herald, August 11, 2008)
Medicare paid dead physicians 478,500 claims totaling up to $92 million from 2000 to 2007. These claims included 16,548 to 18,240 deceased physicians. (U.S. Senate Permanent Committee on Investigations, 2008)
Nearly one of three claims (29 percent) Medicare paid for durable medical equipment was erroneous in FY 2006. (Inspector General report, Department of Health and Human Services, August 2008)
Medicare and private health insurers pay up to $16 billion a year for needless imaging tests ordered by doctors. (American College of Radiology, 2004)
Medicaid Fraud
The 50 state Medicaid fraud control units obtained a collective 1,205 convictions, and claimed total recoveries of more than $1.1 billion in court-ordered restitution, fines, civil settlements, and penalties in FY 2007. (annual report, Office of Inspector General, U.S. Department of Health and Human Services)
Of the 3,308 persons and entities excluded from participation in Medicare, Medicaid and other federal health care programs in FY 2007, 805 were based on referrals made by state Medicaid fraud control units. (ibid)
The number of successful civil actions totaled 607. (ibid)
More than 61 percent of medical providers (4,319 total) banned from state Medicaid programs in 2004 and 2005 didn’t show up in the federal database of state-banned providers. This makes it easier for banned providers to set up shop in other states and continue doing business with federal health-insurance programs. (Office of Inspector General, U.S. Department of Health and Human Services, 2008)
FBI Enforcement (FY 2007)
The FBI investigates persons and organizations that defraud public and private health-insurance programs. The FBI combats fraud and abuse jointly with other federal, state, and local law-enforcement agencies, plus the Centers for Medicare and Medicaid Service, private health insurers and other organizations.
2,493 health-fraud cases investigated, resulting in 839 indictments and 635 convictions. Other cases also are pending plea agreements and trials. (FBI Financial Crimes Report to the Public, FY 2007)
$1.12 billion in court-ordered restitution, $4.4 million in recoveries, $34 million in fines, and 308 seizures valued at $61.2 million. (ibid)
Medical Identity Theft
Medical identity theft is the fastest-growing form of identity theft. (World Privacy Forum, 2006)
Between 250,000 and 500,000 Americans have been victimized by medical identity theft. (World Privacy Forum, 2006)
Medical identity theft comprises about 3 percent (249,000) of 8.3 million overall victims of identity theft. (Federal Trade Commission, Identity Theft Survey Report, 2007)
Nine million adult Americans (4 percent) believe they or a family member has been victimized by medical identity theft. Just under half (47 percent) believe computerized health records are stolen most often. (Harris Interactive, 2008)
75 percent of Americans age 18-49 and 78 percent of Americans age 50-plus are concerned about being victims of identity theft in general. 25 percent of Americans aged 18-49 aren’t concerned and 22 percent of Americans age 50-plus aren’t concerned. (AARP public opinion poll, 2008)
36 percent of Americans age 18-49 and 43 percent of Americans age 50-plus carry their Social Security card in their wallet. (ibid)
40 percent of Americans age 18-49 carry and 57 percent of Americans age 50-plus carry their insurance or Medicare card in their wallet with an ID number that is their or their spouse’s ID number. (ibid)
IRS enforcement
The IRS combats criminal tax and money laundering violations involving insurance claims and fraud against insurance companies. Agent/broker premium diversion and re-insurance fraud are among the internal fraud schemes. Phony insurance companies, offshore/unlicensed Internet insurers and staged auto accidents are among the external fraud schemes.
30 insurance-fraud investigations initiated
21 prosecutions recommended
21 indictments
12 sentenced
83.3 percent incarceration
19-month average to serve
Slip & fall injuries
Swindlers will pretend to slip or trip and injure themselves to fraudulently collect insurance settlements or other payouts. Often the swindlers threaten an expensive lawsuit to extort fast payouts. Businesses are frequent targets.
Three percent of slip-and-fall injuries are fraudulent. (National Floor Safety Institute)
Bogus injury claims and related costs such as litigation amount to nearly $2 billion a year. (ibid)
ANTI-FRAUD LEGISLATION
Insurance fraud is a specific crime in every state except Alabama, Oregon and Virginia.
Employment & education
Employment of insurance fraud investigators, claims adjusters, appraisers and examiners, is expected to grow by 9 percent from 2006 to 20016. This growth is consistent with the average for all occupations. (U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 edition)
The education of fraud investigators, adjusters, appraisers and examiners is divided as follows:
— High school or less: 22 percent— Some college, no degree: 17 percent— Associate’s degree: 12 percent — Bachelor’s degree: 45 percent— Graduate degree: 5 percent. (ibid)
Older statistics
People's Attitudes About Fraud
ConsumersNearly one of four Americans say it’s ok to defraud insurers, says a survey by the consulting firm Accenture Ltd. Some 8 percent say it’s “quite acceptable” to bilk insurers, while 16 percent say it’s “somewhat acceptable.” About one in 10 people agree it’s ok to submit claims for items that aren’t lost or damaged, or for personal injuries that didn’t occur. Two of five people are “not very likely” or “not likely at all” to report someone who ripped of an insurer. Click here for the complete study. Accenture Ltd. (2003) 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. Progressive Insurance (2001)More than one of three Americans say it's ok to exaggerate insurance claims to make up for the deductible (40 percent in 1997). Insurance Research Council (2000)One of four Americans says it's ok to pad a claim to make up for premiums they've already paid. Insurance Research Council (2000) One of three Americans says it's ok for employees to stay off work and receive workers compensation benefits because they feel pain, even though their doctor says it's ok to return to work. Insurance Research Council (1999)Seven of 10 Americans say workers comp fraud is a widespread problem, and 45 percent say fraud is increasing. Insurance Research Council (1999)One of five employed workers says they've been aware of fraud in their workplace. Insurance Research Council (1999)Four of five Pennsylvanians reviewed their medical bills for accuracy in 1999 (seven of 10 in 1997). Insurance Fraud Prevention Authority of Pennsylvania (1999)Nearly 16 percent of Pennsylvanians say they're willing to receive bogus workers comp payments (25 percent in 1997). Insurance Fraud Prevention Authority of Pennsylvania (1999)Three of four Americans aren't willing to pay more for their auto coverage to allow bad-faith third-party lawsuits. Insurance Research Council (2000)
Physicians
Nearly one of three physicians say it's necessary to game the health care system to provide high quality medical care. Journal of the American Medical Association (2000)
More than one of three physicians says patients have asked physicians to deceive third-party payers to help the patients obtain coverage for medical services in the last year. Journal of the American Medical Association (2000)
One of 10 physicians has reported medical signs or symptoms a patient didn't have in order to help the patient secure coverage for needed treatment or services in the last year. Journal of the American Medical Association (2000)
Fraud Losses & Costs
Personal Injury Protection (PIP)
More than one of every three bodily-injury claims from car crashes involve fraud. Insurance Research Council (1996)
17-20 cents of every dollar paid for bodily injury claims from auto policies involves fraud or claim buildup. Insurance Research Council (1996).
Fraud adds $5.2-$6.3 billion to the auto premiums that policyholders pay each year. Insurance Research Council (1996)
Claims for bodily injuries under the Personal Injury Protection portion of New York's no-fault auto coverage rose 79 percent between 1999 and 2000, compared to 25 percent in all no-fault states. Insurance Research Council (2001)
Insurers increased auto premiums up to 25 percent for New York City in 2001. Insurance Information Institute (2001)
The average PIP claim is $7,950 in New York State — 47 percent higher than the national average. Insurance Information Institute (2001)
Fraud costs each insured driver in New York State $75-$115 per year. Insurance Information Institute (2001)
PIP claims in New York State rose nearly one third in 2000, more than twice as fast as second-place Florida. Insurance Information Institute (2001)
The average PIP claim in New York State jumped 19 percent over the first nine months of 2000, and 64 percent between 1995 and 3Q 2000. This compares to a 33-percent increase for other states. Insurance Information Institute (2001)
Auto insurers in New York pay out nearly twice as much in PIP claims as they collect in premiums. For every $100 auto insurers received, they paid $177 in claims through 3Q 2000. Insurance Information Institute (2001)
Arson
Arson and suspected arson account for nearly 500,000 fires a year, or one of every four fires in the U.S. National Fire Protection Association (1998)
Only 2 percent of arson or suspect arson fires result in convictions. National Fire Protection Association (1998)
Arson and suspected arson are the largest causes of property damage in the U.S. National Fire Protection Association (1998)
Anti-Fraud Efforts
State Fraud Bureaus (2001-2002)
Criminal convictions increased 31 percent. Coalition Against Insurance Fraud (2004)
Cases presented for prosecution rose 14 percent. Coalition Against Insurance Fraud (2004)
Investigations initiated increased by nearly 18 percent. Coalition Against Insurance Fraud (2004)
Referrals of suspected fraudulent actions were up 4.5 percent. Coalition Against Insurance Fraud (2004)
Property-casualty insurers
Fraud is a serious problem, half of all property-casualty insurers say. Insurance Research Council-Insurance Services Office (2002)The amount of fraud their company has experienced has increased over the last three years, more than one of three insurers say. Nearly half say fraud has stayed the same. Insurance Research Council-Insurance Services Office (2002)
About 11-30 cents — or more — of every claim dollar is lost to "soft" fraud (smalltime cheating by normally honest people), nearly half of property-casualty insurance companies say. Hardcore scams steal only a small fraction of that money. Insurance Research Council-Insurance Services Office (2002)Only one of four insurers thoroughly investigate cheating on insurance applications. Even fewer insurers investigate insiders such as employees and agents who commit premium fraud. Research Council-Insurance Services Office (2002)More than two of five property-casualty insurers have increased spending to fight fraud over the last three years. More than four of five insurers have formal anti-fraud programs. Insurance Research Council-Insurance Services Office (2002)
Nearly three of five insurers say their efforts to combat are only moderately effective, or lower. Research Council-Insurance Services Office (2002Fraud-control spending by property-casualty insurers rose from $200 million in 1992 to $650 million in 1996. Insurance Research Council (1997)
98 percent of property-casualty insurers have a fraud-control program, and most insurers have special investigation units. Insurance Research Council (1997)
Half of property-casualty insurers have broad, public-information programs directed against fraud. Insurance Research Council (1997)
Workers Compensation
Without workers compensation anti-fraud laws, claims would've been 10.4 percent higher in 1997, the average claim would've been 7.3 percent larger and system costs per worker would've been 18.5 percent higher. National Council on Compensation Insurance (1999)
Healthcare
In 1996, Congress funded an added $548 million over seven years for health-care fraud enforcement. FBI (2001)
Health insurers save $11 for every $1 they spend fighting fraud – an average of $5.5 million per company in 1998. Health Insurance Association of America (1999).
Federal convictions for health fraud, waste and abuse rose 57 percent between 1999 and 1998. U.S. Department of Health and Human Services (2000)
More than nine of 10 health insurers (95 percent) have anti-fraud training for employees, and nearly three of five (56 percent) have fraud hotlines. Health Insurance Association of America (1999)
The FBI secured 560 convictions for healthcare fraud in 2001, a four-fold increase from 1992. The bureau also racked up 741 indictments in 2000, up from 615 in 1999. FBI (2001)
Medicare lost $11.9 billion to waste, fraud and mistakes in 2000, half of what was lost five years ago from improper payments to doctors and hospitals. U.S. Department of Health and Human Services (2001)
Fraud amounts to 10 percent of U.S. healthcare expenditures. Government Accounting Office (1992), National Health Care Anti-Fraud Association (2001)
Seniors and other taxpayers pay up to $1 billion a year in inflated drug prices due to potential fraud and loopholes in Medicare. The overpayments represented 1/5 of Medicare spending in 2000. Government Accounting Office (2001)
80 percent of healthcare fraud is by medical providers, 10 percent is by consumers and the balance is by other sources. Health Insurance Association of America (1998)
The U.S. government recovered more than $8 for every dollar spent fighting health care fraud and abuse by using the False Claims Act. New Directions for Policy (2001)
Identity Theft
Thieves stole the identities of 700,000 Americans last year. The Privacy Clearinghouse (2000)
Identity theft in general cost $745 million in 1997, up from $450 million in 1996. U.S. Secret Service (1998)
Abuse of Social Security numbers nearly tripled between 1998 and 1999, and four of every five calls to the Social Security Administration's fraud hotline involve identity theft. Social Security Administration (1999
Measuring insurance fraud is an elusive target. No single national agency gathers omnibus fraud statistics. Insurance fraud data thus are relatively piecemeal, making our understanding of insurance fraud an ongoing work in progress.
Insurance companies and diverse state and federal agencies each gather fraud data related to their own missions. But the kind, quality and volume of data they compile vary widely.
Independent watchdogs, academics, insurance industry groups and other organizations also conduct research on a variety of fraud topics. Some is national in scope, and some is state-specific.
State insurance fraud bureaus
Fraud bureaus are state agencies charged with investigating suspected insurance schemes within their states. Most states have fraud bureaus, which investigate suspected schemes across most line of insurance. States without multi-line fraud bureaus include: Alabama, Illinois, Indiana, Maine, Michigan, Oregon, Vermont, Wisconsin and Wyoming.
The 2007 annual study of state fraud bureaus by the Coalition Against Insurance Fraud reveals this 2007 combined profile.
Budget
$147,738,214
Employees
1,694
Referrals
115,062
Cases opened
31,654
Arrests
4,848
Presentations to prosecutors
5,936
Convictions
4,228
Civil actions
7,672
Restitution ordered
$179,036,100
Cases reported by the news media so far in 2009.
By type of fraud
Auto insurance
Auto bodily injury claims: Staged-accident rings fleece auto insurers out of billions of dollars a year by billing for unnecessary treatment of phantom injuries. Usually these are bogus soft-tissue injuries such as sore backs or whiplash, which are difficult to medically dispute.
Fraudulent and abusive auto-injury claims are a costly problem. Fraud and “buildup”* added $4.8 billion to $6.8 billion in excess payments to auto injury claims in 2007. That means 13-percent to 18-percent increases in payments under private-passenger auto policies from 2002. (Insurance Research Council, Nov. 2008)
Bogus and abusive claims also are rising. They ranged between $4.3 billion and 5.8 billion in 2002, or between 11 percent and15 percent of total payments. (ibid)
Claims with apparent fraud or buildup were more likely than other claims to involve sprain and strain injuries, and periods of disability. These claimants also were more likely to receive treatment from physical therapists, chiropractors and other alternative medical providers. (ibid) Buildup involves treatment that’s excessive but isn’t deliberately or criminally fraudulent.
Underwriting fraud : Dishonest drivers try to lower auto premiums by dishonestly lying on their insurance application or renewal. Among the ruses: registering their vehicles in locales where premiums are lower; low-balling their stated mileage; and saying a commercial vehicle is used mainly for personal use.
Auto insurers lost $16.1 billion due to premium rating errors in private-passenger premiums in 2007. Premium rating errors account for 10 percent of the $166 billion in personal auto premiums. Fraud accounts for a portion of these losses. Some drivers will seek to lower their premiums by schemes such as deliberately misrepresenting mileage driven, how the vehicle is used and where it’s registered. (Quality Planning Corporation, 2008)
Workers compensation
Some businesses illegally try to avoid paying full state-required workers compensation premiums. One scheme involves paying workers off the books because the number of employees is a factor in determining a business’s premiums. Another scheme involves misclassifying employees in high-risk jobs as holding lower-risk jobs.
At least 50,000 construction workers in New York City — one of four —are paid off the books or misclassified as independent contractors. (Fiscal Policy Institute, 2007)
Those schemes stole $489 million in workers compensation premiums, taxes and other expenses in 2005. That figure could reach $557 million in 2008. (ibid)
More than 39,500 employers misclassify 704,785 workers — or 10.3 percent of the workforce — throughout New York State each year. (Linda H. Donahue, James Ryan Lamare, and Fred B. Kotler,Cornell University, 2007)
In construction, 45,474 workers — or 14.8 percent of New York’s workforce — are misclassified as independent contractors. (ibid)
Employers in high-risk California industries may hide up to 75 percent of their payroll — or $100 billion — for the most-dangerous jobs. This forces honest employers to pay workers comp premiums as much as eight times higher than if everyone paid their fair share. (Frank Neuhauser and Colleen Donovan, University of California-Berkeley, 2007)
Every $1 invested in workers compensation anti-fraud efforts has returned $6.17, or $260.3 million total in 2006-2007. (California Insurance Department, 2007 annual report)
Workers comp insurers in Massachusetts lose $100 million a year in unpaid premiums to businesses that illegally pay workers cash under the table or falsely label employees as independent contractors. (Social and Economic Costs of Employee Misclassification in Construction, Harvard University, December 2004)
As many as one of seven construction workers in Massachusetts is hired off the books or illegally classified as independent workers. (ibid)
Consumer attitudes
Consumer tolerance of insurance fraud remains relatively high, public-opinion polls have consistently shown in recent years. The coalition’s study is the newest national research into what people think about this crime.
One of five U.S. adults — about 45 million people — say it’s acceptable to defraud insurance companies under certain circumstances. Four of five adults think insurance fraud is unethical. (Four Faces of Insurance Fraud, Coalition Against Insurance Fraud, 2008)
Nearly one of four Americans says it’s ok to defraud insurers (8 percent say it’s “quite acceptable” to bilk insurers, and 16 percent say it’s “somewhat acceptable.”) (Accenture Ltd., 2003)
About one in 10 people agree it’s ok to submit claims for items that aren’t lost or damaged, or for personal injuries that didn’t occur. Two of five people are “not very likely” or “not likely at all” to report someone who defrauded an insurer. (ibid)
Consumer tolerance of specific insurance schemes has increased over the last 10 years, reveals the Four Faces study. There is a decline in the number of Americans who think it’s unethical to:
misrepresent facts on an insurance application to lower their premiums (82 percent today, down from 91 percent in 1997);
file a claim for damage that occurred before the damage was covered (85 percent, down from 91 percent);
inflate a claim to cover the deductible (84 percent, down from 91 percent); and
misrepresent an incident in order to be paid for an uncovered loss (84 percent, down from 92 percent).
Consumer attitudes toward insurance providers also have declined over the last 10 years, according to Four Faces:
62 percent of people have a positive attitude about insurance companies (down from 72 percent in 1997); and
Fewer than two of five adults feel positively about the insurance industry as a whole (down from slightly more than 50 percent).
Health insurance
In general
The U.S. spends more than $2 trillion on healthcare annually. At least 3 percent of that spending — or $68 billion — is lost to fraud each year. (National Health Care Anti-Fraud Association, 2008)
Private health insurance
Every $2 million invested in fighting health-care fraud returns $17.3 million in recoveries, court-ordered judgments, plus bogus claims that weren’t paid and other anti-fraud savings. (National Health Care Anti-Fraud Association, 2008)
The average health insurer’s anti-fraud investigative unit has an annual budget of slightly more than $1.9 million and 19 fulltime employees. (ibid)
The average health insurer has 363 open cases in 2007, and each insurer investigation unit handled an average of 791 cases total for 2007. (ibid)
More than seven of 10 insurer investigative units use fraud-detection software. (ibid)
Drug diversion
Insurance fraud is a major financier of America’s epidemic diversion of addictive prescription drugs such as OxyContin, according to Prescription for Peril, a December 2007 report by the Coalition Against Insurance Fraud.
Drug diversion costs health insurers up to $72.5 billion a year in bogus claims involving opioid abuse alone;
Private health insurers lose up to $24.9 billion annually;
Diversion costs individual private insurance plans up to $857 million annually;
Nearly half of Aetna’s member/pharmacy anti-fraud team’s caseload involved prescription benefits in 2006;
Expenses of suspected doctor-shopping members of Medco Health Solutions were nearly seven times higher than the monthly cost of members without excessive prescription claims; and
Abuse suspects incurred $41 in claims for office visits and outpatient treatment for every $1 in narcotic prescription claims against WellPoint.
Whistleblower Lawsuits
The federal False Claims Act allows whistleblowers to obtain a portion of any federal civil recoveries stemming from the whistleblower’s efforts to expose fraud against programs. Whistleblowers account for a major portion of healthcare convictions because they tend to be insiders at the offending healthcare organizations, and thus have unique access to information needed to charge and convict.
$1.55 billion in civil settlements and judgments from 218 cases in 2007 in which the Department of Health and Human Service was the primary client agency. (U.S. Department of Justice)
$13.2 billion in total civil settlements from 3,665 cases from 1987 through 2007. (ibid)
Whistleblowers received an average of 16.84 percent of recoveries when the federal government intervened. (Taxpayers Against Insurance Fraud, 2008)
The federal government recovers $15 for every $1 invested in False Claims Act health-care investigations and prosecutions. (Taxpayers Against Fraud, 2008)
Medicare Fraud
Medicare’s annual anti-fraud budget is $465 billion. (Miami Herald, August 11, 2008)
Medicare and Medicaid made an estimated $23.7 billion in improper payments in 2007. These included $10.8 billion for Medicare and $12.9 billion for Medicaid. Medicare’s fee-for-service reduced its error rate from 4.4 percent to 3.9 percent. (U.S. Office of Management and Budget, 2008)
Medicare and Medicaid lose an estimated $60 billion or more annually to fraud, including $2.5 billion in South Florida. (Miami Herald, August 11, 2008)
Every $1 spent on Medicare fraud prevention would stop $10 in fraud. (U.S.Department of Health and Human Services) (Miami Herald)
Medicare spends less than 0.2 cents of every $1 of its $456 billion annual budget combating fraud, waste and abuse. (Miami Herald, August 11, 2008)
Medicare paid dead physicians 478,500 claims totaling up to $92 million from 2000 to 2007. These claims included 16,548 to 18,240 deceased physicians. (U.S. Senate Permanent Committee on Investigations, 2008)
Nearly one of three claims (29 percent) Medicare paid for durable medical equipment was erroneous in FY 2006. (Inspector General report, Department of Health and Human Services, August 2008)
Medicare and private health insurers pay up to $16 billion a year for needless imaging tests ordered by doctors. (American College of Radiology, 2004)
Medicaid Fraud
The 50 state Medicaid fraud control units obtained a collective 1,205 convictions, and claimed total recoveries of more than $1.1 billion in court-ordered restitution, fines, civil settlements, and penalties in FY 2007. (annual report, Office of Inspector General, U.S. Department of Health and Human Services)
Of the 3,308 persons and entities excluded from participation in Medicare, Medicaid and other federal health care programs in FY 2007, 805 were based on referrals made by state Medicaid fraud control units. (ibid)
The number of successful civil actions totaled 607. (ibid)
More than 61 percent of medical providers (4,319 total) banned from state Medicaid programs in 2004 and 2005 didn’t show up in the federal database of state-banned providers. This makes it easier for banned providers to set up shop in other states and continue doing business with federal health-insurance programs. (Office of Inspector General, U.S. Department of Health and Human Services, 2008)
FBI Enforcement (FY 2007)
The FBI investigates persons and organizations that defraud public and private health-insurance programs. The FBI combats fraud and abuse jointly with other federal, state, and local law-enforcement agencies, plus the Centers for Medicare and Medicaid Service, private health insurers and other organizations.
2,493 health-fraud cases investigated, resulting in 839 indictments and 635 convictions. Other cases also are pending plea agreements and trials. (FBI Financial Crimes Report to the Public, FY 2007)
$1.12 billion in court-ordered restitution, $4.4 million in recoveries, $34 million in fines, and 308 seizures valued at $61.2 million. (ibid)
Medical Identity Theft
Medical identity theft is the fastest-growing form of identity theft. (World Privacy Forum, 2006)
Between 250,000 and 500,000 Americans have been victimized by medical identity theft. (World Privacy Forum, 2006)
Medical identity theft comprises about 3 percent (249,000) of 8.3 million overall victims of identity theft. (Federal Trade Commission, Identity Theft Survey Report, 2007)
Nine million adult Americans (4 percent) believe they or a family member has been victimized by medical identity theft. Just under half (47 percent) believe computerized health records are stolen most often. (Harris Interactive, 2008)
75 percent of Americans age 18-49 and 78 percent of Americans age 50-plus are concerned about being victims of identity theft in general. 25 percent of Americans aged 18-49 aren’t concerned and 22 percent of Americans age 50-plus aren’t concerned. (AARP public opinion poll, 2008)
36 percent of Americans age 18-49 and 43 percent of Americans age 50-plus carry their Social Security card in their wallet. (ibid)
40 percent of Americans age 18-49 carry and 57 percent of Americans age 50-plus carry their insurance or Medicare card in their wallet with an ID number that is their or their spouse’s ID number. (ibid)
IRS enforcement
The IRS combats criminal tax and money laundering violations involving insurance claims and fraud against insurance companies. Agent/broker premium diversion and re-insurance fraud are among the internal fraud schemes. Phony insurance companies, offshore/unlicensed Internet insurers and staged auto accidents are among the external fraud schemes.
30 insurance-fraud investigations initiated
21 prosecutions recommended
21 indictments
12 sentenced
83.3 percent incarceration
19-month average to serve
Slip & fall injuries
Swindlers will pretend to slip or trip and injure themselves to fraudulently collect insurance settlements or other payouts. Often the swindlers threaten an expensive lawsuit to extort fast payouts. Businesses are frequent targets.
Three percent of slip-and-fall injuries are fraudulent. (National Floor Safety Institute)
Bogus injury claims and related costs such as litigation amount to nearly $2 billion a year. (ibid)
ANTI-FRAUD LEGISLATION
Insurance fraud is a specific crime in every state except Alabama, Oregon and Virginia.
Employment & education
Employment of insurance fraud investigators, claims adjusters, appraisers and examiners, is expected to grow by 9 percent from 2006 to 20016. This growth is consistent with the average for all occupations. (U.S. Department of Labor, Occupational Outlook Handbook, 2008-09 edition)
The education of fraud investigators, adjusters, appraisers and examiners is divided as follows:
— High school or less: 22 percent— Some college, no degree: 17 percent— Associate’s degree: 12 percent — Bachelor’s degree: 45 percent— Graduate degree: 5 percent. (ibid)
Older statistics
People's Attitudes About Fraud
ConsumersNearly one of four Americans say it’s ok to defraud insurers, says a survey by the consulting firm Accenture Ltd. Some 8 percent say it’s “quite acceptable” to bilk insurers, while 16 percent say it’s “somewhat acceptable.” About one in 10 people agree it’s ok to submit claims for items that aren’t lost or damaged, or for personal injuries that didn’t occur. Two of five people are “not very likely” or “not likely at all” to report someone who ripped of an insurer. Click here for the complete study. Accenture Ltd. (2003) 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. Progressive Insurance (2001)More than one of three Americans say it's ok to exaggerate insurance claims to make up for the deductible (40 percent in 1997). Insurance Research Council (2000)One of four Americans says it's ok to pad a claim to make up for premiums they've already paid. Insurance Research Council (2000) One of three Americans says it's ok for employees to stay off work and receive workers compensation benefits because they feel pain, even though their doctor says it's ok to return to work. Insurance Research Council (1999)Seven of 10 Americans say workers comp fraud is a widespread problem, and 45 percent say fraud is increasing. Insurance Research Council (1999)One of five employed workers says they've been aware of fraud in their workplace. Insurance Research Council (1999)Four of five Pennsylvanians reviewed their medical bills for accuracy in 1999 (seven of 10 in 1997). Insurance Fraud Prevention Authority of Pennsylvania (1999)Nearly 16 percent of Pennsylvanians say they're willing to receive bogus workers comp payments (25 percent in 1997). Insurance Fraud Prevention Authority of Pennsylvania (1999)Three of four Americans aren't willing to pay more for their auto coverage to allow bad-faith third-party lawsuits. Insurance Research Council (2000)
Physicians
Nearly one of three physicians say it's necessary to game the health care system to provide high quality medical care. Journal of the American Medical Association (2000)
More than one of three physicians says patients have asked physicians to deceive third-party payers to help the patients obtain coverage for medical services in the last year. Journal of the American Medical Association (2000)
One of 10 physicians has reported medical signs or symptoms a patient didn't have in order to help the patient secure coverage for needed treatment or services in the last year. Journal of the American Medical Association (2000)
Fraud Losses & Costs
Personal Injury Protection (PIP)
More than one of every three bodily-injury claims from car crashes involve fraud. Insurance Research Council (1996)
17-20 cents of every dollar paid for bodily injury claims from auto policies involves fraud or claim buildup. Insurance Research Council (1996).
Fraud adds $5.2-$6.3 billion to the auto premiums that policyholders pay each year. Insurance Research Council (1996)
Claims for bodily injuries under the Personal Injury Protection portion of New York's no-fault auto coverage rose 79 percent between 1999 and 2000, compared to 25 percent in all no-fault states. Insurance Research Council (2001)
Insurers increased auto premiums up to 25 percent for New York City in 2001. Insurance Information Institute (2001)
The average PIP claim is $7,950 in New York State — 47 percent higher than the national average. Insurance Information Institute (2001)
Fraud costs each insured driver in New York State $75-$115 per year. Insurance Information Institute (2001)
PIP claims in New York State rose nearly one third in 2000, more than twice as fast as second-place Florida. Insurance Information Institute (2001)
The average PIP claim in New York State jumped 19 percent over the first nine months of 2000, and 64 percent between 1995 and 3Q 2000. This compares to a 33-percent increase for other states. Insurance Information Institute (2001)
Auto insurers in New York pay out nearly twice as much in PIP claims as they collect in premiums. For every $100 auto insurers received, they paid $177 in claims through 3Q 2000. Insurance Information Institute (2001)
Arson
Arson and suspected arson account for nearly 500,000 fires a year, or one of every four fires in the U.S. National Fire Protection Association (1998)
Only 2 percent of arson or suspect arson fires result in convictions. National Fire Protection Association (1998)
Arson and suspected arson are the largest causes of property damage in the U.S. National Fire Protection Association (1998)
Anti-Fraud Efforts
State Fraud Bureaus (2001-2002)
Criminal convictions increased 31 percent. Coalition Against Insurance Fraud (2004)
Cases presented for prosecution rose 14 percent. Coalition Against Insurance Fraud (2004)
Investigations initiated increased by nearly 18 percent. Coalition Against Insurance Fraud (2004)
Referrals of suspected fraudulent actions were up 4.5 percent. Coalition Against Insurance Fraud (2004)
Property-casualty insurers
Fraud is a serious problem, half of all property-casualty insurers say. Insurance Research Council-Insurance Services Office (2002)The amount of fraud their company has experienced has increased over the last three years, more than one of three insurers say. Nearly half say fraud has stayed the same. Insurance Research Council-Insurance Services Office (2002)
About 11-30 cents — or more — of every claim dollar is lost to "soft" fraud (smalltime cheating by normally honest people), nearly half of property-casualty insurance companies say. Hardcore scams steal only a small fraction of that money. Insurance Research Council-Insurance Services Office (2002)Only one of four insurers thoroughly investigate cheating on insurance applications. Even fewer insurers investigate insiders such as employees and agents who commit premium fraud. Research Council-Insurance Services Office (2002)More than two of five property-casualty insurers have increased spending to fight fraud over the last three years. More than four of five insurers have formal anti-fraud programs. Insurance Research Council-Insurance Services Office (2002)
Nearly three of five insurers say their efforts to combat are only moderately effective, or lower. Research Council-Insurance Services Office (2002Fraud-control spending by property-casualty insurers rose from $200 million in 1992 to $650 million in 1996. Insurance Research Council (1997)
98 percent of property-casualty insurers have a fraud-control program, and most insurers have special investigation units. Insurance Research Council (1997)
Half of property-casualty insurers have broad, public-information programs directed against fraud. Insurance Research Council (1997)
Workers Compensation
Without workers compensation anti-fraud laws, claims would've been 10.4 percent higher in 1997, the average claim would've been 7.3 percent larger and system costs per worker would've been 18.5 percent higher. National Council on Compensation Insurance (1999)
Healthcare
In 1996, Congress funded an added $548 million over seven years for health-care fraud enforcement. FBI (2001)
Health insurers save $11 for every $1 they spend fighting fraud – an average of $5.5 million per company in 1998. Health Insurance Association of America (1999).
Federal convictions for health fraud, waste and abuse rose 57 percent between 1999 and 1998. U.S. Department of Health and Human Services (2000)
More than nine of 10 health insurers (95 percent) have anti-fraud training for employees, and nearly three of five (56 percent) have fraud hotlines. Health Insurance Association of America (1999)
The FBI secured 560 convictions for healthcare fraud in 2001, a four-fold increase from 1992. The bureau also racked up 741 indictments in 2000, up from 615 in 1999. FBI (2001)
Medicare lost $11.9 billion to waste, fraud and mistakes in 2000, half of what was lost five years ago from improper payments to doctors and hospitals. U.S. Department of Health and Human Services (2001)
Fraud amounts to 10 percent of U.S. healthcare expenditures. Government Accounting Office (1992), National Health Care Anti-Fraud Association (2001)
Seniors and other taxpayers pay up to $1 billion a year in inflated drug prices due to potential fraud and loopholes in Medicare. The overpayments represented 1/5 of Medicare spending in 2000. Government Accounting Office (2001)
80 percent of healthcare fraud is by medical providers, 10 percent is by consumers and the balance is by other sources. Health Insurance Association of America (1998)
The U.S. government recovered more than $8 for every dollar spent fighting health care fraud and abuse by using the False Claims Act. New Directions for Policy (2001)
Identity Theft
Thieves stole the identities of 700,000 Americans last year. The Privacy Clearinghouse (2000)
Identity theft in general cost $745 million in 1997, up from $450 million in 1996. U.S. Secret Service (1998)
Abuse of Social Security numbers nearly tripled between 1998 and 1999, and four of every five calls to the Social Security Administration's fraud hotline involve identity theft. Social Security Administration (1999
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