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