Insurance Fraud Investigations
Insurance fraud investigations by CRI® cover the full range of cases, from healthcare fraud to disability and even fake death claims. Our experts are trained to look for the tell-tale signs of fraud: they can view claims, medical and hospital records, conduct interviews, examine statements and documents, as well as perform on-site inspections. Insurance fraud is something that no company can afford.
Insurance fraud is a serious crime that can result in serious consequences for fraudsters who may find their future job prospects impacted, find it harder to obtain insurance and other vital financial services, obtain a criminal conviction and even face the prospect of imprisonment (ABI, titled “Fraud”, 2018).
We will work with you and all appropriate insurance personnel to achieve the results you need in a timely, discreet manner. CRI® agents bring their investigative training to careful use in every engagement, protecting your confidentiality while uncovering the facts of the case.
CRI® handles several forms of investigations, including, but not limited to:
Interested in learning more? Explore our other investigative solutions.
If you think that fraud is limited to automobiles and healthcare, consider all of the types of insurance available – and know that all of them are susceptible to fraud. In fact, insurance fraud investigators from Business insurance have provided a list titled “10 Most Common Types of Insurance Fraud.” These cases even include staged home fires and faked deaths:
- Car damage
- Staged home fires
- Health insurance billing fraud
- Storm fraud
- Faked death
- Abandoned house fire
- Car accident
- Renter’s insurance
- Unnecessary medical procedures
- Stolen car
Interested in learning more? Explore our other investigative solutions.
Every type of insurance is vulnerable to insurance fraud. Insurance fraud cases are often committed by opportunists – such as claim fraud, where perpetrators invent or exaggerate a claim; or application fraud, where they deliberately or recklessly provide false information when applying for insurance. There are well-known cases of highly organised criminal gangs with money-making enterprises based on insurance fraud.
Insurance fraud cases cover a wide range of schemes and crimes, intended to enrich the fraudsters at the expense of insurance providers and other innocent victims. With the enormous liability presented by insurance fraud, every organisation should address the risk in their due diligence and fraud prevention programs.
The experts at CRI® are positioned to help any organisation, including captive insurance companies, domestic, alien, Lloyds of London, mutual and stock companies implement this as part of a risk management plan.
When fraud is detected, CR®I Group’s investigations cover the full range of insurance fraud cases, from healthcare fraud to disability and even fake death claims. CRI® Group’s experts are thoroughly trained, for example, to look for the tell-tale signs of fraud through carefully reviewing claims, medical and hospital records, conducting interviews, examining statements and documents and performing on-site inspections. Our agents leave no stone unturned when investigating suspected insurance fraud.
Learn more about how insurance fraud investigation services can help your business.
- Does the claim include expensive property, often newly purchased without documentation, allegedly destroyed along with the home?
- Is sentimental property suspiciously not listed among the missing/destroyed property?
- The claimant cannot provide detailed descriptions of the destroyed property or where it was purchased?
- Does the documentation provided by the claimant looks altered or irregular?
- What the claimant claims in property loss does not match the physical site?
- The claimant refuses to answer questions, or gives confused or inconsistent answers?
- The claimant fails to provide additional documentation when asked, even if he promises to do so?
If your answer is yes to any of these red flags, then you may have a case of insurance fraud in your hands.
- Buy enough coverage to protect your company assets.
- Add surveillance cameras to record “high-risk” areas.
- Perform background checks.
- Limit access to your inventory.
- Check references provided by new hires.
- Add dashboard cams to your service or delivery vehicles.
- Do the bills appear irregular, or documentation is incomplete?
- There is a history of claims by the subject for different, seemingly unrelated health procedures or
- Dates and locations for hospital visits seem unlikely or cannot be corroborated with verified records?
- The claimant avoids answering questions about the claim or gives confusing or inconsistent answers?
If your answer is yes to any of these red flags, then you may have a case of insurance fraud in your hands.
When red flags of fraud are uncovered, it’s time to begin an investigation. As you can see from the examples above, CRI® Group’s investigations are based on a thorough approach that includes site visits and leaving no stone unturned. When you work with CRI®, this is how the process will typically proceed. CRI® will:
- Assign the appropriate investigators with the right expertise in that area to investigate the claim.
- Contact the parties involved to gather all relevant details about the incident.
- Use all resources available, including police reports, court filings, database records and other means to establish the truth in insurance fraud cases.
- Make site visits, speak to witnesses, take photos and establish timelines as needed to create a full, truthful story of the incident.
- Uncover useful evidence, carefully documenting and preserving it in a way that is admissible in court.
- Present investigation findings to the client, with recommendations on how to proceed. Sometimes, legal action is warranted.
Working with an insurance fraud investigation company like CRI® provides the advantage of having an independent, impartial and unbiased third-party collecting the facts you need regarding any case that might involve potential fraud.
CRI® has been safeguarding businesses for more than 30 years, and you will be assured of the quality, professionalism and discreet nature of all investigations conducted by our experts.
Our global presence ensures that no matter how international your operations are, CRI® Group’s investigations have the network needed to provide you all necessary support, wherever you happen to be. We take great care to ensure that our trained and licensed investigators are the best at what they do.
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CRI® Group and ABAC® Center of Excellence CEO Mr. Zafar Anjum was a speaker at last week’s ABAC at MACC 2019 Seminar Benchmark on Governance, Integrity & Anti-Corruption. Mr. Anjum presented “Anti-Bribery Management System (ABMS...Read More
Bribery and corruption are worldwide problems with serious consequences for organisations of any size, industry or region. To help combat this threat, the International Organization for Standardization (ISO) issued the ISO 37001:2016 Anti-Bribery Management System...Read More
Corruption: a Real Threat to Organisations Worldwide For ages, systematic bribery was tolerated in various countries and industries as a "necessary part of getting business done or circumventing bureaucratic red tape." The times are changing,...Read More
Award-winning Information Technology Services company ISS Middle East FZC (IntelliSoft) has successfully demonstrated compliance with ISO 37001 requirements and attained ABAC Certification in ISO 37001:2016 Anti-Bribery Management System (ABMS) for services such as SAP Professional,...Read More
It's a well-known World Bank statistic, but one that bears continual repeating: More than US$1.5 trillion – or 2% of world gross domestic product – is paid in bribes each and every year, contributing to...Read More
Pharma and Healthcare Companies can Benefit from ISO 37001 When global pharmaceutical giant GlaxoSmithKline found itself in the Chinese government’s crosshairs for an alleged large-scale bribery scandal, there was perhaps little doubt that the consequences...Read More
Risk management requires continuous improvement. Without a company culture strongly aligned with principles of continuous improvement, organisations will struggle to implement, let alone maintain, successful risk management programs. This can be challenging in practice, as...Read More
As the international outcry on bribery and corruption practices continues to tighten its grip around rogue players in the private and public business sectors, global organisations continue to ramp up their efforts to develop effective...Read More
Most organisations manage some of their risks via an insurance policy and risk retention. However, this is a reactive strategy when it comes to risk. If you are one of these organisations, then you are...Read More
Talent acquisition in the hiring process requires a great deal of investment in both time and effort for the hiring manager and would involve even greater repercussions if the chosen candidate turns out to be...Read More
CRI® Group’s 3rd ABAC Summit 2019 Sets the Tone at the Top CRI® Group, a global leader in risk and compliance hosted the “3rd Anti-Bribery Anti-Corruption Summit 2019” in association with ICCI, GPCCI, Bank Al...Read More
CRI® Group is once again a proud supporter of International Fraud Awareness Week, Nov. 11-17, 2018. This global movement aims to minimise the impact of fraud by promoting anti-fraud awareness and education. Companies lose an estimated...Read More
We at the CRI Group believe that businesses that are being run free of corruption accomplish their vision and mission sooner and easier. They bring good to the world more effectively than others. When a...Read More
How to Protect Your Business from Money Laundering Activities? Today, having anti-money laundering processes in place is more than a matter of smart business. In most jurisdictions, it is also a legal necessity. Organisations large...Read More
In today’s business environment, fraudulent practices and manipulating the trust of others is so commonplace that people do it very often and with confidence. Unfortunately, this is also true when it comes to employment, as...Read More
Money laundering should be near the top of the list of any business owner’s concerns. Anti-money laundering legislation and regulations are strict and increasingly enforced, and remaining in compliance through implementing proper prevention controls is...Read More
Thank you for attending the ABAC Summit Malaysia last Tuesday! We are proud to have brought such an amazing group of distinguished speakers and respected delegates together to address the bribery and corruption issues worldwide. We...Read More
In one case, an enforcement agent for a Malaysian government department pleaded guilty for receiving a bribe from a business owner. In another, a U.S. district attorney from Philadelphia was accused of taking cash in...Read More
Once upon a time, the idea of business ethics was more of an abstract or philosophical notion that seemed more suited for discussion in a university lecture or at a business conference. Today, however, organisations...Read More
One of the most important aspects of any organisation is its culture. How do employees relate to one another? Is it a positive and enriching place to work? Do employees trust their colleagues, and look...Read More
An extra layer of security As a global investigative firm with a network of 76 agents worldwide, CRI® Group has the resources and expertise needed to implement thorough and comprehensive pre-and post-employment screening. As part...Read More
Managing the third party risk Managing the third party risk. It's highly probable that, at some point, organisations that affiliate with outside providers will eventually have to deal with an operational interruption resulting from a...Read More
Bribery and corruption are serious concerns to businesses, government agencies and non-profit organisations. In fact, the risk of being associated with the negative impacts of this type of fraud extends to third party partners and...Read More
CRI® Group's Third-Party Risk Assessments are front-line tools used to ascertain whether an organisation has the appropriate policies and procedures in place to address all potential risks at the management, operations and financial levels and...Read More
Recently, South African President Jacob Zuma resigned in a late-night address to the country. This week, politicians and pundits continue to reflect on what led to his downfall – which, even in the midst of...Read More
On November 29, 2017, Deputy Attorney General Rod Rosenstein revealed the implementation of the FCPA Corporate Enforcement Policy ("Enforcement Policy"), which endeavours to supplemental reassure voluntary disclosure of FCPA violations by companies. The Enforcement Policy...Read More
The news broke across Saudi Arabia and the world like a bombshell: a wide-ranging corruption sweep across the country had netted 11 princes, four sitting cabinet members and a dozen former government ministers. Among those...Read More
Last Thursday, 26 October, the region’s leading anti-fraud professionals gathered in Karachi, Pakistan, for CRI® Group’s Pakistan’s 1st ever Anti-Bribery Summit. CRI® Group took the initiative to organise the first Anti-Bribery Summit in Pakistan with...Read More
Pakistan’s biggest lender, Habib Bank Ltd, faces compliance failures. Habib Bank is in trouble with the New York State Department of Financial Services (DFS). The DFS is the governing body that regulates financial services and products (including those...Read More
COVID-19 has significantly changed the business landscape. With budgets slashed, events cancelled, and consumer behaviour shifting, businesses are having to change too. PwC’s 2020 Global Consumer Insights survey shows a shift in the consumer’s priority...Read More
The 2017 SHRM Annual Conference & Exposition kicked off yesterday in New Orleans, and CRI® Group is proud to be participating as an exhibitor and telling top human resource managers about EmploySmart. SHRM is the Society for Human Resource Management,...Read More
From the Guardian brexit corruption Brexit could damage the UK’s efforts to tackle corruption and give multinationals leverage over the British government in bribery cases, the Organisation for Economic Co-operation and Development has warned. Business pressure...Read More
Ethics hotlines are growing in popularity. In 2017 the South Africa Home Affairs Minister Malusi Gigaba announced over 3,000 officials were found guilty of misconduct related to cases reported via the National Anti-Corruption Hotline (NACH). “The...Read More
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