Fraud investigation
Why do i need a fraud investigation?
If you are the victim of a scam, you may lose significant amounts of money and, in some cases, your good name. Proving a fraud actually occurred, however, can be complicated and evidence you gather on your own may not be admissible in court. A qualified, experienced investigator helps you receive the compensation you deserve.
what is a fraud investigation?
A fraud investigation determines whether a scam has taken place and gathers evidence to protect the victims involved.
Fraud is misrepresentation with the intent to deceive. For example, if a company makes a specific claim about a product won’t as promised, they are guilty of fraud. Fraud is a very real and costly problem that causes loss of money as well as serious injury and sometimes even death.
What Happens during fraud investigations
Fraud investigations being with a meeting between the investigations and client. The person launching the investigation explains why they suspect deceit and hands over any evidence they have supporting their claims. A good fraud investigator will use this initial information to find more evidence and information. To do this, they may use surveillance, asset searches, background checks, employee investigations, business investigations, and other methods.
Different types of frauds investigations
Insurance fraud
Involves individuals who make false claims to receive insurance money or insurance companies who refuse to honor legitimate claims.
Identity fraud
With identity theft, investigators will look for a faulty loan or credit card applications, false withdrawals from bank accounts, dishonest use of calling cards, and using an alternate name to receive benefits.
transit fraud
This kind of fraud occurs when passengers on buses, subways, or streetcars don’t remain seated or hold rails and fall when the vehicle stops. There are also cases in which individuals allow their feet to be run over or stand in the way of the mirror.
Expense claim fraud
When employees pocket runover business expenses they are committing fraud. Often, individuals will claim to stay in hotels costing $200 a night when in reality, they stay in cheap motels and keep the remainder of the money.
Corporate Fraud
Includes issues like theft of information, compromised customer information, and a damaged reputation.
internet fraud
Internet fraud occurs when criminals attempt to take advantage of victims via the internet. This includes the theft of personal information of fraudulent transaction that results in the significant loss of money.
ticket fraud
With ticket fraud, a person will purchase tickets for a sporting event or concert that aren’t legitimate. Often these tickets have already been used or don’t exist.
Theft of inventory
With theft of inventory, investigators will look into whether employees steal products or order more than the store needs. Sometimes employees will claim products are expired when they aren’t so they can take the items home.
Financial Fraud
Tax evasion, public corruption, health care fraud, telemarketing fraud, and terrorist financing all fall under Finacial Fraud.
Corporate Slip & Fall
This type of fraud involves individuals who purposely organize a fall while inside a store in order to file a claim. They will go as far as to throw water on the floor in order to ensure a slip.
Mechanical Repair Fraud
Often a mechanic will call for fixes that are overpriced or not necessary.
What is an Insurance fraud investigation
An insurance fraud investigation is a type of fraud investigation that centers around attempts to benefit from deceitful claims. Seeking compensation for false or inflated claims is illegal, dangerous, and raises the price of insurance for everyone.
According to the Coalition Against Insurance Fraud, an $80 billion is paid out annually in fraudulent insurance claims. This leads to the average household paying around $950 each year in higher premiums. Also, being held liable in a staged accident can increase your risk of being sued
The prevalence of this type of fraud has resulted in insurance companies acting with caution when paying claims, meaning you may need professional help when making your claim. An insurance fraud investigation aids by revealing false claims. Don’t let your insurance premiums be a waste of money; use a private investigator to safeguard your insurance privileges.
Health Insurance:
This investigation determines whether someone is getting paid for health care they are not receiving or is filing health care claims that are not valid or needed. Investigators will search billing records to make sure that doctors and patients are not conspiring to commit fraud.
Home Insurance:
With home insurance fraud, investigators disaster fraud, including false damage claims. They will often determine if the claimant upgraded their coverage right before the claim was filed. Investigators will also verify the validity of property damage claims.
Worker Compensation Insurance:
When workers claim compensation for an injury, workers compensation investigation will confirm the severity of the damage and whether the accident occurred while the person was working.
Car Insurance:
Some criminals stage accidents in which they purposely collide with another car, then accuse the other driver of fault in order file claims. Others attempt vehicle theft fraud, trying to get money for a vehicle that is not stolen.
Life Insurance:
This type of investigation uncover cases of people who claim too much life insurance or claim it while still alive. Investigators also verify the existence of those claiming life insurance.
Insurance Company Fraud:
Unethical practices can also occur within the insurance companies themselves. If an insurance company takes money but does not sufficiently compensate, an investigator can aid with resulting court cases.
How is an Insurance fraud investigation conducted
There are several methods used to information is an insurance fraud investigation. Most are used to determine whether claims are true or false. Here are a few commonly used techniques.
- Surveillance to verify the claim
- Medical reports/history search
- Previous claims/accidents search
- Insurance coverage analysis
- Witness interview
- Physician’s billing search and analysis
- Claimant background check
Isn’t an Insurance Investigation Just for Insurance companies?
Absolutely not, when people seek to make fraudulent insurance claims, they often attempt to make claims from the estate of someone else they’ve implicated in the accident. For example, if someone sideswipes your car and then claims you’re at fault, not only will your premiums increase, but the criminal may target you to