Life insurance fraud may involve faking death to claim life insurance. Fraudsters may sometimes turn up a few years after disappearing, claiming a loss of memory.
An example of life insurance fraud is the John Darwin disappearance case, which was an investigation into the act of pseudocide committed by the British former teacher and prison officer John Darwin, who turned up alive in December 2007, five years after he was thought to have died in a canoeing accident. Darwin was reported as “missing” after failing to report to work following a canoeing trip on March 21, 2002. He reappeared on December 1, 2007, claiming to have no memory of the past five years.
Another example of fraud is former British Government minister John Stonehouse who went missing in 1974 from a beach in Miami. He was discovered living under an assumed name in Australia, extradited to Britain and jailed for seven years for fraud, theft and forgery.
Health care Insurance fraud
Member fraud consists of ineligible members and/or dependents, alterations on enrollment forms, concealing pre-existing conditions, failure to report other coverage and prescription drug fraud.
Provider fraud consists of claims submitted by bogus physicians, billing for services not rendered, billing for higher level of services, diagnosis or treatments that are outside the scope of practice, alterations on claims submissions, and providing services while under suspension or when license have been revoked.
Some fraud involve double-billing by doctors who charge insurers for treatments that never occurred and surgeons who perform unnecessary surgery.
Some Physicians use several fraudulent techniques. These can include:
- “up-coding” or “upgrading,” which involve billing for more expensive treatments than those actually provided;
- providing and billing for treatments that are not medically necessary;
- scheduling extra visits for patients;
- referring patients to another physician when further treatment is not necessary;
- “phantom billing,” or billing for services not rendered;
- “ganging,” or billing for services to family members or other individuals who accompany the patient but don’t receive treatment.
Perhaps the highest valued fraud is committed by health insurance companies themselves. There are numerous examples of insurance companies intentionally not paying claims and deleting them from their systems,denying and cancelling coverage, and blatant underpayment to hospitals and physicians, lower than normal fees.