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Insurance fraud or false insurance claims are insurance claims filed with the intent to defraud an insurance provider.
In the United States, insurance fraud is estimated to cost $875 per person per year, with The Coalition Against Insurance Fraud
estimating the loss to be $80 billion per year, and Medicare estimating
fraud in its system costs the government $179 billion per year.
Insurance fraud hurts the average person in two ways. First, all
fraud costs, including losses, investigations, etc., are paid for by
the insured through higher premiums, or, in the case of government
insurance like Medicare, in higher taxes. Second, if a particular
individual is the target for the fraud, they have costs such as
deductible payments, loss of property use, etc., as well as higher
premiums from the claim loss and the potential for denial of future
coverage.
Some memorable examples of insurance fraud include the following:
- Former British Government minister John Stonehouse went missing in 1974 from a beach in Miami. He was discovered living under an assumed name in Australia.
- Derek Nicholson and Nikole Nagle were accused of attempting to defraud a life insurance company for $1 million after Mr. Nicholson apparently went missing in New Jersey in July 2003 and Ms. Nagle reported him missing and made a claim on the policy.
- Gaylan Sweet of San Diego, California, who was a claims adjuster for Allstate
Insurance, set up a scheme in 2002 that included non-existent children
who were killed in hit-and-run auto accidents at non-existent
intersections by phantom drunk drivers. Sweet and two others (who posed
as the parents of the non-existent children) pocketed $710,000 before
being caught by Allstate.
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