If you want to understand why insurance companies hire private insurance fraud investigators, consider this quote from the NorthJersey.com, the online home of The Record:
“Three former chiropractors from Bergen and Passaic counties were sentenced to five years of probation Monday for setting up a fraudulent practice in Paterson and cheating more than 30 insurance companies out of what prosecutors say was millions.”
Yes, you read that correctly – MILLIONS! The three medical services providers received sentences and were ordered to pay a total of $250,000 in restitution. But they cost the insurance companies millions of dollars, in fact it is reported that the three generated $2.8 million in fraudulent billings.
When is called into a case like this, we know that it often results in criminal charges and, interesting enough, it usually is tied to another investigation such as a long term disability insurance fraud investigation, a personal injury investigation or a slip and fall accident investigation.
Wide spread abuse by medical services providers means that as investigators and claims adjustors review and work on their cases, they watch for red flags that could signal abuse or fraud. And since medical services are provided and part of the surveillance on personal injury investigations, their practices are reviewed.
In the end, the three chiropractors admitted to submitting misleading and fraudulent claims to more than 30 insurance companies.
It’s not funny at all – to the insurance company and certainly not to the customers who have to carry the burden of the fraud in their premiums.
And it’s not funny what the paper reported the ringleader said to the judge. He told him he would find another line of work. He said, ““One hundred percent, I am never going into this business again. I have two small children. I never went into this business intending to commit a crime. But for me, I would get in trouble again immediately. I have learned from this.”
works closely with many insurance carriers as personal injury investigators, workers compensation fraud investigators and all types of insurance fraud investigators – not only is it the right thing to do, we pay insurance premiums, too!
-Brenda McGinley, CEO, All in Investigations, All in Investigations