What is Insurance Fraud?
How are you affected? Insurance fraud occurs when a material fact is knowingly misrepresented or omitted in order to obtain something of value or to gain some advantage. Insurance fraud is a significant problem that has a direct impact on you, the consumer. It is estimated that insurance fraud costs Americans at least $80 billion dollars a year.* It is often mistaken as a victimless crime, but in reality it victimizes everyone by making insurance products and your insurance premiums more expensive.
Life insurance fraud may involve faking a death, murder for insurance, or an insured person who misrepresents his or her medical history or tobacco usage. Or it can involve more elaborate schemes by organized groups that create phony insured identities or fraudulently use the viatical process. Disability insurance fraud may involve misrepresenting a disability or failing to disclose a known, pre-existing medical history, or it may involve a claimant who is working in his or her occupation while collecting disability benefits. Dental or vision insurance fraud may involve billing for services that were not performed, or it may involve misrepresentation of the date a service was performed, the person receiving the services, or the person performing the services.
It is our mission to pay only legitimate claims. Fighting fraud is a priority, and we are committed to pursuing those who misrepresent the facts in order to collect money to which they are not entitled.
What can be done to help?
Information from citizens like you can be instrumental in helping our experienced employees identify suspicious events surrounding a claim. If you have reason to suspect insurance fraud, we encourage you to report your knowledge or observations by contacting us directly.
If you suspect insurance fraud, help us fight fraud and the associated costs. Call our Fraud Hotline at 800-228-4062 or complete our Suspected Fraud Form.
Additional information can be found at insurancefraud.org.
* Coalition Against Insurance Fraud, 2019.