Why Insurance Fraud Succeeds

Published: Jan. 19, 2023, 4:16 p.m.

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It is Time For Insurers to be Proactive Against Fraud 

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There has been much hand wringing and wailing over the malfeasance of the  corporate officers and directors of FTX Crypto Exchange, Enron,  WorldCom and others. No one, however, has gone to the root causes of the  situation. 

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It should be a foremost duty of the insurance industry to do  whatever it can to defeat insurance fraud and work to compel  prosecutors, police officers, fraud division of fraud bureau  investigators, SIU investigators, and claims handlers to work to deter  or defeat insurance fraud.  It is not that some corporate executives, suddenly turned to the dark  side and became evil. It is not that police and prosecutors have turned  to the dark side. It is, I submit, because they were all trained by the  Department of Justice and local prosecutors to believe that there was  almost no penalty for their crimes.  White-collar crime, especially insurance fraud, has been ignored for the  last three decades as a serious crime.  A crime unpunished emboldens others who might never consider a life of  crime to pursue wealth the easy way.  

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Prosecution of what the Coalition Against Insurance Fraud contends is a  $308 billion annual insurance fraud take, the massive crime perpetrated  against insurers and government \\u201cinsurance\\u201d programs like Medicare are  miniscule, to the point of non-existence. Fraud is rampant and almost  universally unpunished. Every year more than $100 billion is stolen from  Medicare and Medicaid programs across the country while private  property and casualty insurers lose a similar loss closer to $200  billion every year to insurance criminals.

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