Insurance Fraud CasebookPaying a Premium for Crime
Real case studies on insurance fraud written by real fraud examiners Insurance Fraud Casebook is a one-of-a-kind collection consisting of actual cases written by fraud examiners out in the field. These cases were hand selected from hundreds of submissions and together form a comprehensive picture of the many types of insurance fraud—how they are investigated, across industries and throughout the world. Entertaining and enlightening, the cases cover every type of insurance fraud, from medical fraud to counterfeiting. Each case outlines how the fraud was engineered, how it was investigated, and how perpetrators were brought to justice Written for fraud examiners, auditors, and insurance auditors Other titles by Wells: Fraud Fighter and Corporate Fraud Handbook, Third Edition Edited by Dr. Joseph T. Wells, the founder and Chairman of the Association of Certified Fraud Examiners (ACFE), the world's leading anti-fraud organization, this book reveals the dangers of insurance fraud and the measures that can be taken to prevent it from happening in the first place.
Preface ix Insurance Fraud Classification System xiii Chapter 1 Needles in a Paystack 1Charles Piper Chapter 2 The Good Doctor and Insurance Consultant 11Michael King Chapter 3 Greasing the Wheels in the Oil Business 21Abdulrazaq Al-Morjan Chapter 4 Living the Dream, Keeping Up the Lie 31Andries J. Brummer Chapter 5 Extinguishing an Arson Fraud 39Barry Zalma Chapter 6 Weakest Link in the Chain 47Angela Bisasor Chapter 7 Everyone Gets Hurt: A Study in Workers' Compensation Fraud 57Michael Sputo Chapter 8 The Hazards of Doing Business with Friends 67Bill Maloney Chapter 9 There's Gold in Them Thar Malls! 75Carl Knudson Chapter 10 Damsel in Diamonds 83Michael Skrypek Chapter 11 Operation Give and Go 93Edward P. Buttimore Chapter 12 An Inspection Is Worth a Thousand Photos 103Ed Madge Chapter 13 The Danger of Trusting Too Much 113Joe Bonk Chapter 14 The Twin Cities Machine 121Bob Weir Chapter 15 With Friends Like These . . . 131John Fifarek Chapter 16 All the Buzz 139Dalene Bartholomew Chapter 17 Getting Rich from the Elderly 149John R. Holley Chapter 18 Transparent Greed 159Joseph Licandro Chapter 19 Fault of Fortune 169Jyoti Khetarpal Chapter 20 Going Blind to Fraud 179Karen Wright Chapter 21 Going Against the Cartel 191Loftin C. Woodiel Chapter 22 Falling Prey to Online Charms 199Tina Hancock Chapter 23 Big Bills in Little Cuba 209Mark Starinsky Chapter 24 Rushing an Insurance Claim 217Peter Parillo Chapter 25 Ignorance Is Bliss, While It Lasts 229Rebecca Busch Chapter 26 The Name Game 239William D. Meader Chapter 27 Woo, Wed, Insure, Murder 249William P. Hight Chapter 28 Mystery Shopping for Fraud 259Stephen Pedneault Index 269
LAURA HYMES, CFE, is the Managing Editor of the ACFE's Research Department, where she oversees the editing of books, manuals and other publications related to the prevention, detection and investigation of fraud. She also collaborates with authors and speakers who are experts in the anti-fraud industry to produce high-quality educational material. She has a master's degree in publication management and years of experience in editing and publishing. Dr. JOSEPH T. WELLS, CFE, CPA, spent nearly a decade as a U.S. FBI Special Agent and is the founder and Chairman of the Association of Certified Fraud Examiners (ACFE) as well as the author of twenty-one books. For his landmark research in fraud detection and deterrence, Dr. Wells has been inducted into the American Institute of Certified Public Accountants' Business and Industry Hall of Fame and named to Accounting Today's list of the 100 most influential people for nine years in a row. He holds a doctorate in commercial science from York College, The City University of New York.
Insurance fraud is not committed by accounting systems or computers. It's carried out by living, breathing human beings, victimizing fellow consumers and costing millions of dollars in the form of increased premiums and higher prices for goods and services. If you want to learn how insurance fraud is engineered, how it is investigated and how its perpetrators are brought to justice, Insurance Fraud Casebook is a must-read. Edited by Laura Hymes, Managing Editor of the Association of Certified Fraud Examiners' (ACFE) Research Department and Dr. Joseph T. Wells, the founder and Chairman of the ACFE, Insurance Fraud Casebook is a behind-the-scenes look at how insurance fraud takes root. Featuring contributions by fraud examiners, the book details the measures that can be taken to keep fraud from happening in the first place through real cases, all handpicked by Laura Hymes. Insurance Fraud Casebook provides you with special insights on every type of insurance scam, from healthcare fraud and workers' compensation fraud to counterfeiting and online fraud, illustrated with entertaining and enlightening cases, including: " The Good Doctor and Insurance Consultant" "Extinguishing an Arson Fraud" " Everyone Gets Hurt: A Study in Workers' Compensation Fraud" "Getting Rich from the Elderly" "Falling Prey to Online Charms" "Woo, Wed, Insure, Murder" "Mystery Shopping for Fraud" Understanding the enormity of this problem is essential in fighting back. Whether you're a fraud investigator or an insurance auditor, Insurance Fraud Casebook is your best source for optimizing your fraud detection efforts and protecting against insurance fraud.
Praise for Insurance Fraud Casebook "From kickbacks to murder and physicians to cartels, these case studies read like a novel, yet provide practical and relevant considerations. This is a must-read for any professional working in the insurance arena." —Tiffany R. Couch, CFE, CPA/CFF, Principal, Acuity Group PLLC "Thirty-five years of police work and financial investigation taught me that there is just no substitute for experience, but if you haven't been there, learn from somebody who has. This compendium is an entertaining, enlightening, and practical aid for everyone who has an interest in fraud detection. I heartily recommend it." —Roy Burnett, MS, CFE, Fraud Investigator, EE Ltd "Can a book on insurance fraud be a great read? This one can: Armenian arsonists-for-profit, new tricks in identity theft and embezzlement, Russian mobster rip-offs and even manipulation of murder. A superb collection of the unusual, the tragic and the amusing, this is a casebook invaluable to the fraud investigation professional as well as students." —Douglas M. Watson, PhD, CFE-RE, Point~CounterPoint Consultations, Izmir, Turkey "Once again, the ACFE has produced a collection of excellent cases on the subject of fraud. In addition to very detailed case stories, an excellent 'Lessons Learned' section is included at the end of each chapter. This book brings fraud to life for students of fraud examination." —Ron McNinch, PhD, CFE, SPHR, Public Administration and Legal Studies Chair, University of Guam "This book is a great illustration of the depth and breadth of insurance fraud schemes and of the cost that we all pay for them. The examples and case studies are both informative and intellectually entertaining. A great read for everyone, from fraud examiners to basic insurance consumers." —Ryan C. Hubbs, CFE, CIA, CCSA, PHR, Forensic Audit Manager, Internal Audit Services, Halliburton
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