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Insurance Fraud Casebook: Paying a Premium for Crime

Book Description

Real case studies on insurance fraud written by real fraud examiners

Insurance Fraud Casebook is a one-of-a-kind collection consisting of actual cases written by fraud examiners out in the field. These cases were hand selected from hundreds of submissions and together form a comprehensive picture of the many types of insurance fraud—how they are investigated, across industries and throughout the world. Entertaining and enlightening, the cases cover every type of insurance fraud, from medical fraud to counterfeiting.

  • Each case outlines how the fraud was engineered, how it was investigated, and how perpetrators were brought to justice

  • Written for fraud examiners, auditors, and insurance auditors

  • Other titles by Wells: Fraud Fighter and Corporate Fraud Handbook, Third Edition

  • Edited by Dr. Joseph T. Wells, the founder and Chairman of the Association of Certified Fraud Examiners (ACFE), the world's leading anti-fraud organization, this book reveals the dangers of insurance fraud and the measures that can be taken to prevent it from happening in the first place.

    Table of Contents

    1. Cover Page
    2. Title Page
    3. Copyright
    4. Dedication
    5. Contents
    6. Preface
    7. Insurance Fraud Classification System
    8. CHAPTER 1: Needles in a Paystack
      1. A Growing Company
      2. Another New Case on My Desk
      3. Rolling Up Our Sleeves
      4. Presenting the Facts for Justice
      5. About the Author
    9. CHAPTER 2: The Good Doctor and the Insurance Consultant
      1. A Growing Company
      2. On a Hunch
      3. Paging Dr. Ahmet
      4. Working Thrsough the Pain
      5. Indisputable Evidence
      6. Trend Setting
      7. About the Author
    10. CHAPTER 3: Greasing the Wheels in the Oil Business
      1. Long-Distance Call for Help
      2. A Groundbreaking Case
      3. Looking Outside for Suspects
      4. Lack of Accountability
      5. About the Author
    11. CHAPTER 4: Living the Dream, Keeping Up the Lie
      1. The Family Illness
      2. Watching and Waiting
      3. About the Author
    12. CHAPTER 5: Extinguishing an Arson Fraud
      1. Backyard Barbecue
      2. Expanding the Team
      3. Good Faith Is Easily Exploited
      4. Lazy Appraisal Work
      5. Outcome of the Investigation
      6. About the Author
    13. CHAPTER 6: Weakest Link in the Chain
      1. The Unexpected Meeting
      2. The Interview
      3. The Interrogation
      4. The Second Interview and Interrogation
      5. The Crime Ring Breaks
      6. About the Author
    14. CHAPTER 7: Everyone Gets Hurt: A Study in Workers' Compensation Fraud
      1. Bundled and Bungled
      2. Unlikely Rescuer
      3. Crash Course in Insurance
      4. Tracking the Letters of Credit
      5. It All Comes Together
      6. About the Author
    15. CHAPTER 8: The Hazards of Doing Business with Friends
      1. It Started with a Single Call
      2. Understanding the Industry
      3. What Jack Did Not Know
      4. It Does Not End with a Confession
      5. Plea Deal
      6. About the Author
    16. CHAPTER 9: There's Gold in Them Thar Malls!
      1. When It Rains, It Pours
      2. Divide and Conquer
      3. Just the Tip of the Iceberg
      4. Whistleblower, Beware
      5. Complications Begin to Mount
      6. Delay, Delay and Delay!
      7. Our Team Enters the Fray
      8. An Outcome, Not a Resolution
      9. About the Author
    17. CHAPTER 10: Damsel in Diamonds
      1. Viceroy Jewelers
      2. One Thing Leads to Another
      3. The Truth Comes Out
      4. Solving the Paperwork Puzzle
      5. Duty Calls
      6. Police Involvement
      7. About the Author
    18. CHAPTER 11: Operation Give and Go
      1. Designing a Sting
      2. The First Deal
      3. On a Roll
      4. Unexpected Consequences
      5. Successful Sting
      6. About the Author
    19. CHAPTER 12: An Inspection Is Worth a Thousand Photos
      1. Start Your Engines
      2. Bringing on a Navigator
      3. Becoming Car Buffs
      4. Seeing What's Behind the Photos
      5. One More for the Road
      6. About the Author
    20. CHAPTER 13: The Danger of Trusting Too Much
      1. A Single Suspicious Check
      2. Climbing the Fraud Ladder
      3. Surprise Interview
      4. Where Did It Go?
      5. About the Author
    21. CHAPTER 14: The Twin-Cities Machine
      1. Running a Machine
      2. The Team Versus the Machine
      3. Ambulance Chasers, Runners and the Mob
      4. Interviews
      5. Medical Mill
      6. Out of Sight, Not Out of Mind
      7. The Big Picture
      8. About the Author
    22. CHAPTER 15: With Friends Like These . . .
      1. False Alarm?
      2. Nagging Suspicions
      3. Mounting Dread
      4. Now What?
      5. Justice
      6. About the Author
    23. CHAPTER 16: All the Buzz
      1. Partnerships in Action
      2. Confirmed Suspicions
      3. Lying Under Oath
      4. Understanding the Elements
      5. Preparing for Legal Action
      6. Realities of the Courtroom
      7. The Verdict Is Only the First Step
      8. About the Author
    24. CHAPTER 17: Getting Rich from the Elderly
      1. The Promises of the Plan
      2. A Different Side of Betty Comes Out
      3. The Complaints Keep Coming
      4. Unwelcome Visitors
      5. The Plan Fails
      6. About the Author
    25. CHAPTER 18: Transparent Greed
      1. Business as Usual
      2. Imitation Is the Highest Form of Flattery
      3. Glass Star's Evolution
      4. The New Guard in Full Swing
      5. A Holdout from the Old Guard
      6. Brand New to the Job
      7. Gathering Witnesses
      8. About the author
    26. CHAPTER 19: Fault of Fortune
      1. The Ethical Dilemma
      2. The Consortium and Its Needs
      3. The Reservations
      4. The Investigation
      5. Veracity Test
      6. Too Good to Be True
      7. The Interview
      8. About the author
    27. CHAPTER 20: Going Blind to Fraud
      1. Popular with the Auditors
      2. Second Opinion
      3. The First Visit
      4. Audits and Reports
      5. Fraud Referral
      6. Tallying the Losses
      7. About the Author
    28. CHAPTER 21: Going Against the Cartel
      1. The Cartel Climate
      2. Acceptable Expenditures
      3. Strange Bedfellows
      4. The Plan in Action
      5. David Beats Goliath
      6. About the Author
    29. CHAPTER 22: Falling Prey to Online Charms
      1. A Good Deal Gone Bad
      2. Call for Help
      3. Seeing the Big Picture and the Red Flags
      4. Revealing Records
      5. Satisfied Customers
      6. About the Author
    30. CHAPTER 23: Big Bills in Little Cuba
      1. Dusty Shelves
      2. Whack-A-Mole
      3. Store Visit
      4. House Calls
      5. The Truth Comes Out
      6. About the Author
    31. CHAPTER 24: Rushing an Insurance Claim
      1. Second Generation
      2. Unwelcoming Client
      3. Spending Spree
      4. The Robbery
      5. The Rush Ends
      6. About the Author
    32. CHAPTER 25: Ignorance Is Bliss, While It Lasts
      1. No Experience Necessary
      2. Second Chance
      3. Nitty-Gritty Fraud Examination
      4. Bribes, Donations, Rebates and Consignments
      5. About the Author
    33. CHAPTER 26: The Name Game
      1. Not Just Another Case
      2. Beware of Intentionally Complicated Structures
      3. Repeat Offender
      4. Piling Up Boxes
      5. You Can't Plan for Everything
      6. About the Author
    34. CHAPTER 27: Woo, Wed, Insure, Murder
      1. We Have a History
      2. Character Testimonials
      3. Different Kinds of Evidence
      4. About the Author
    35. CHAPTER 28: Mystery Shopping for Fraud
      1. Silver Star
      2. Independent Expertise
      3. Shopping Trip
      4. Broken Paper Trail
      5. Under Oath
      6. Settlement Discussions
      7. About the Author
    36. Index