What are the Best Tips for Reporting Insurance Fraud?

Lainie Petersen

Reporting insurance fraud is an important way for consumers to help keep the cost of insurance premiums down and to ensure that insurance covers legitimate needs. To report insurance fraud, individuals should learn about options available in their area. For example, some governments sponsor their own insurance fraud hotlines and reporting services. Other options for reporting insurance fraud include contacting insurance companies directly or reporting businesses and licensed professionals to oversight boards for investigation.

Businessman with a briefcase
Businessman with a briefcase

In situations where a person suspects insurance fraud, it is a good idea to try and determine the nature of the fraud and the identity of the company or organization that provides the insurance. For example, in the United States people with disabilities may receive benefits through private disability insurance plans as well as through government disability plans such as Social Security. If someone suspects or knows that a recipient of disability insurance has lied about his condition, reporting that individual for insurance fraud may be a matter of determining whom to contact. If the individual is covered under private disability insurance, contacting that company directly is probably the best option, whereas Social Security maintains its own fraud reporting services.

One pernicious type of insurance fraud is perpetrated not by health care consumers, but by providers. In some cases, doctors and chiropractors bill insurance companies for procedures, equipment, and medications that are never actually used. Reporting insurance fraud in these cases can involve several steps, which may include direct reporting to insurance companies, a government insurance fraud agency, as well as the appropriate licensing board for further insurance fraud investigation. When reporting insurance fraud, it is important to be able to describe one's suspicions and if possible provide documentation for one's claims.

Other insurance fraud cases involve property rather than human beings. Sometimes body shops recommend unnecessary automobile repairs to claim additional insurance money and may even attempt to persuade car owners to consent to these repairs by offering rebates or other items of value. Another more potentially dangerous type of insurance fraud is a staged accident or arson that involves damage to a property or automobile so its owners can collect insurance money. Reporting insurance fraud in these cases is important because of the potential risk to innocent people often involved in such cases. If an individual suspects that insurance fraud is involved, she may want to approach local law enforcement with her suspicions as well as insurers and industry groups.

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