Claimant & Provider Fraud Section

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Common Types & Schemes

Avoid Becoming a Victim

Reporting Insurance Fraud

Common Types & Schemes

Staged Vehicle Accidents

• Swoop and Squat -  The "squat" vehicle slows down in front of the victim's vehicle.  The "swoop" vehicle changes lanes in front of the "squat" vehicle as it comes to a sudden stop.  The victim vehicle is unable to stop and rams the "squat" vehicle.  The "swoop" vehicle leaves the scene.  Popular targets are vehicles perceived to be fully insured, luxury cars, female or elderly drivers, and single occupant vehicles.
• Drive-down or Wave-on -  The suspect waves to the victim to proceed (e.g. out of a parking space) then purposefully drives into the victim's vehicle, making it appear the victim is at fault.
• Sideswipe - Suspect intentionally drifts into the outer lane while turning left from the inner lane of a dual-turn highway, causing the victim to hit his vehicle.
• Hit and Run - Using a pre-damaged vehicle, the suspect falsely reports being involved in a hit and run accident.
• Paper Accidents - Fabricating an accident report in order to collect insurance money for pre-existing damage.

Vehicle Theft/Arson Fraud

• Owner Give-up - Vehicle owner files a false vehicle theft claim to collect insurance money.  Common reasons include costly mechanical problems or inability to make monthly payments.
• Vehicle Switch - An older or damaged vehicle is purchased at a modest price.  Photos of a newer, undamaged vehicle are provided to purchase insurance.  Within 6 months the vehicle is reported stolen and a claim is filed with the insurance company.  The claim is paid, resulting in a huge profit.

Personal Injury Fraud

• "Slip and Fall" - Hot spots for faking injuries include grocery stores, department stores and government facilities.
• Exaggerating an injury to increase insurance benefits.

False Burglary and/or Theft Reports 

• Claimant falsely reports items lost in burglary or theft.  The property may have been removed prior to the report.  False police reports are made in an effort to substantiate the claim.  Receipts for missing property are altered or fabricated.  Multiple policies may be purchased to cover the same loss.

Health Care and Provider Fraud

• Health care provider bills for services and/or supplies not provided.
• Provider deliberately performs medically unnecessary services, claiming they were medically necessary.
• Clinic or hospital bills for services provided by an unlicensed provider.
• Durable medical equipment provider bills for new equipment when used parts were utilized or bills for equipment that was never provided.
• Cross border billing - Texas provider bills for services provided in Mexico.
• Third party administrator bills for services not performed or bills with a reimbursement code for a complicated procedure rather than the simple procedure provided.

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Avoid Becoming a Victim

When Driving

• Look beyond the vehicle in front of you
• Allow ample space between your vehicle and the vehicle ahead of you

If You Are in a Collision

• Call the police
• Count the number of passengers in the other vehicle
• Record the names and telephone numbers of all individuals involved
• Carry a disposable camera in your glove box to take pictures at the scene
• Notify your insurance company as soon as possible