b'
HTTPS://zalma.com/blog
\\nThis fraud technique involves a loss at a time when an individual has no or inadequate insurance. Following the loss, the individual applies for insurance or increases the limits of existing coverage. After a period of time (usually several days or weeks), a fraudulent claim is submitted for a loss reported to have happened after the new policy came into effect. Failure of the insurer, or its agent, to see the property (especially if the insurer has included the items on its schedules) before issuance of a policy is an invitation to this type of fraud. There is an unwritten exclusion in every insurance policy that requires that every covered loss must be fortuitous, that is, be the result of a contingent or unknown event. Attempting to post-date an auto loss is often difficult and if there is a police report, impossible.Insurance policies typically come into effect at 12:01 a.m., standard time on the day the policy is purchased. If a person has an auto accident, fire or theft at 10:00 a.m. he may go to an insurance agent, purchase a policy that goes into effect at 12:01 a.m. that day, and make claim on the new policy.Because the insurance fraud perpetrator will report that the loss occurred the day after the policy date, this type of scheme usually fails. When there is evidence that the insured knew about the incident before the policy was acquired or that there exists evidence when it actually happened, like a police or fire report, this type of fraud will fail. Paper Property This sort of fraud involves property that never existed or was never owned by the insured. It can be the most difficult type of staged loss to defeat. Paper property can appear in a staged loss or in a legitimate claim, where paper property is used to inflate the claim amount. In the presentation of the claim, the insured produces a receipt (original or duplicate) or an appraisal. The document is either fraudulent (examples include the use of computers or even white-out paint and a photocopier to change the name of the owner) or represent the value of an item owned by another individual.For example, an insured who purchased jewelry at a department store on a credit card, took the jewelry to an appraiser, returned the jewelry for full credit and then reported it stolen. The jewelry (no longer in her possession) was then insured by means of the appraisal and a loss was reported shortly thereafter. The receipt presented to the insurer was legitimate and if the receipt was not verified with the vendor the fact that it was returned and is still in inventory at the vendor will never be discovered.In one of my cases my investigator went to the vendor to verify the sales receipt. It was verified and then the vendor asked the investigator: \\u201cwould you like to see it?\\u201d He then pulled the item out of a showcase and provided the investigator with the receipt showing he refunded the insured the purchase price when it was returned. Health Insurance Fraud The nation\\u2019s bill for health care fraud is enormous \\xbe as large as $300 billion or more every year. Fraud takes place at many points in the health care system, in hospitals, nursing homes, and diagnostic facilities, by doctors, attorneys, health care providers, durable equipment providers, and patients.One large area prone to fraud is the Medicare system. This system processes more than 800 million claims a year with 70 different contractors handling the claims that come from hundreds of thousands of doctors, laboratories, and other health practitioners and facilities. \\xa9 2021 \\u2013 Barry Zalma
\\n\\n--- \\n\\nSupport this podcast: https://podcasters.spotify.com/pod/show/barry-zalma/support'