Author: Barry Zalma Publisher: ISBN: 9781704294742 Category : Languages : en Pages : 460
Book Description
Insurance Fraud Is Epidemic Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. Most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year.Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance criminals is endemic. Most insurance fraud criminals are not detected. Those that are detected do so because they became greedy, sloppy and unprofessional so that the attempted fraud becomes so obvious it cannot be ignored.The National Insurance Crime Bureau (NICB) estimates that almost 25% of the bodily injury claims related to auto crashes are bogus. Property and casualty claims against auto insurance are not much better, coming in at around a 10% fraud rate.A person commits the offense of insurance fraud by knowingly and with the intent to defraud any insurer presents or causes to be presented to any insurer any statement forming a part of, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim. [18 Pa.C.S.A. § 4117(a)(2).] A person acts "knowingly" when he or she is aware that it is practically certain that his or her conduct will cause such a result. Likewise, a person acts "intentionally" when "it is his or her conscious object to engage in conduct of that nature or to cause such a result.As the industry attempts to keep pace with fraudsters' varied, ever-shifting tactics, it must deploy more innovative, effective anti-fraud technologies or risk dire losses. Vendors and organizations include the Coalition Against Insurance Fraud (CAIF), CSC, Detica NetReveal, Equifax, Experian, FICO, IBM, Innovation Group, Insurance Bureau of Canada (IBC), ISO/Verisk, KPMG, LexisNexis, Mattersight, Mitchell, the National Insurance Crime Bureau (NICB), SAP, SAS, and TransUnion.Insurers must also generate a close relationship with the state insurance department's fraud division or fraud bureau, local police agencies, the FBI, the ATF, the Postal Investigation Service, the local fire department's arson unit, local prosecutors, and the local U.S. Attorneys if they are to have any chance to reduce the effect of insurance fraud. Insurers should also work to make the general public, state legislators, state governors, congress members and U.S. Senators, and the Attorney General of the United States aware of the effect insurance fraud has on the public at large and the insurance industry.Wherever insurance is written insurance fraud exists. It is an equal opportunity fraud committed by people of every race, religion or national origin. Insurers who do not exercise serious anti-fraud efforts often complain that the local district attorneys and police agencies give a low priority to the crime of insurance fraud. No matter how seriously the insurers work to prove fraud the authorities often ignore them. In response, police and prosecutors complain that the insurers do nothing that police and prosecutors can use to prosecute the crime of insurance fraud while insurers complain that prosecutors ignore them when they present evidence of a fraud. There is truth in both complaints. Insurers, although compelled by statute to investigate potential insurance fraud and to present the results of their investigations to prosecutors, they are not trained as police officers. This book is written to make it clear to insurers, police and prosecutors that it is necessary to stop complaining and start working together to reduce the extent of insurance fraud. If they do not work together the crime will continue to metastasize until it will be impossible to write insurance at a profit or for a price anyone can afford.
Author: Malcolm K Sparrow Publisher: Basic Books ISBN: 0465010741 Category : Political Science Languages : en Pages : 306
Book Description
Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
Author: Howard Silverstone Publisher: John Wiley & Sons ISBN: 047172713X Category : Business & Economics Languages : en Pages : 258
Book Description
Unique insights into the nature of fraud and how to expose it It's not enough to wait for a tip to expose corporate fraud. Fraud 101, Second Edition provides step-by-step guidance on how to perform detection procedures for every major type of fraud. Its new and detailed case studies reveal how easy it can be for a perpetrator to commit a fraud and how difficult it can be to prosecute. This new edition also offers expanded coverage of financial statement fraud, fraud-specific internal control, and Sarbanes-Oxley.
Author: David F. Bradford Publisher: University of Chicago Press ISBN: 0226070328 Category : Political Science Languages : en Pages : 218
Book Description
The Economics of Property-Casualty Insurance presents new research and findings on key aspects of the economics of the property-casualty insurance industry. The volume explores the industrial organization, regulation, financing, and taxation of this business. The first paper, on external financing and insurance cycles, contains a wealth of information on trends and patterns in the industry's financial structure. The last essay, which compares performance of stock and mutual insurance companies, takes a fresh look at the way a company's organizational structure affects its responses to different economic situations. Two papers focus on rate regulation in the auto insurance industry, and provide broad overviews of the structure and economics of the insurance industry as a whole. Also addressed are the system of regulating insurance companies in the United States, who insures the insurers, and the effects of tax law changes in the 1980s on the prices of insurance policies.
Author: Jay M. Feinman Publisher: Penguin ISBN: 1101196289 Category : Business & Economics Languages : en Pages : 247
Book Description
An expose of insurance injustice and a plan for consumers and lawmakers to fight it Over the last two decades, insurance has become less of a safety net and more of a spider's web: sticky and complicated, designed to ensnare as much as to aid. Insurance companies now often try to delay payment of justified claims, deny payment altogether, and defend these actions by forcing claimants to enter litigation. Jay M. Feinman, a legal scholar and insurance expert, explains how these trends developed, how the government ought to fix the system, and what the rest of us can do to protect ourselves. He shows that the denial of valid claims is not occasional or accidental or the fault of a few bad employees. It's the result of an increasing and systematic focus on maximizing profits by major companies such as Allstate and State Farm. Citing dozens of stories of victims who were unfairly denied payment, Feinman explains how people can be more cautious when shopping for policies and what to do when pursuing a disputed claim. He also lays out a plan for the legal reforms needed to prevent future abuses. This exposé will help drive the discussion of this increasingly hot- button issue.
Author: AICPA Publisher: John Wiley & Sons ISBN: 1945498528 Category : Business & Economics Languages : en Pages : 688
Book Description
Get authoritative accounting and auditing guidance. Educate staff on the property and liability insurance industry, its products and regulatory issues, and the related transaction cycles an insurance entity is involved with. This guide contains updates on current GAAP and statutory accounting and audit guidance, as well as relevant guidance contained in standards issued through September 1, 2018 which have a major impact on insurance entities, including: FASB ASU No. 2016-01 and AICPA Q&A Section 7100.15: Insurance Companies and the Definition of Public Business Entity Revenue Recognition Implementation Issue: Considerations for Applying the Scope Exception in FASB ASC 606-10-15-2 and 606-10-15-4 to Contracts Within the Scope of FASB ASC 944
Author: AICPA Publisher: John Wiley & Sons ISBN: 1119699045 Category : Business & Economics Languages : en Pages : 671
Book Description
Stay up−to−date on current GAAP and statutory accounting and audit guidance for property and liability insurance entities. This guide provides a good grounding on the industry, its products and regulatory issues, and the related transaction cycles that a property and liability insurance entity is involved with. Relevant guidance contained in standards issued through September 1, 2019, is covered, including the following: FASB ASU No. 2017−12, Derivatives and Hedging (Topic 815): Targeted Improvements to Accounting for Hedging Activities SSAP No. 26R, Bonds SSAP No. 43R, Loan-backed and Structured Securities SSAP No. 97, Investments in Subsidiary, Controlled and Affiliated Entities Revised for SSAP No. 101, Income Taxes, and NAIC INT 18−03, Additional Elements Under the Tax Cuts and Jobs Act Key topics covered: Understand current GAAP and statutory accounting for property and liability insurance entities. Get authoritative accounting and auditing guidance applicable to property and liability Understand current GAAP and statutory accounting for property and liability insurance entities. Get authoritative accounting and auditing guidance applicable to property and liability insurance entities. Properly develop an audit plan for auditing loss reserves. Easily educate your staff on property and liability insurance.
Author: Barry Zalma
Author: Malcolm K Sparrow
Author: Howard Silverstone
Author: David F. Bradford
Author: 
Author: Jay M. Feinman
Author: 
Author: AICPA
Author: Mark Goldburd
Author: AICPA