NCJ Number
121468
Journal
Security Management Volume: 33 Issue: 9 Dated: (September 1989) Pages: 63-66
Date Published
1989
Length
4 pages
Annotation
This article describes investigative techniques for frauds involving insurance employees.
Abstract
Two common internal frauds are "add-a-claimant" and "add-a-payment" schemes. In the former, a claim handler will annotate the claim file to reflect that an additional automobile was damaged or an additional person was injured in an accident. In add-a-payment schemes, the claim handler locates a claim that has been closed and reports that the policyholder or claimant has additional expenses to be compensated. Having ordered or written the fraudulent check, the employee must have a safe way to acquire it if the procedures call for all negotiable instruments to be mailed and a safe method for converting the check or draft into cash. Often an accomplice is used to receive the check, or the employee may use a fictitious name. When an investigator is suspicious that such fraud is occurring, the subsequent investigation must be kept confidential. After identifying the most likely suspect, steps are to review the employee's personnel file, to search for additional similar frauds, and to review claim files to determine if similarly named payees have had claims processed by the suspect. The most pervasive and difficult type of employee insurance fraud involves kickbacks, typically in cases of auto body or home repairs. The article suggests investigative techniques for such cases.