The Coalition Against Insurance Fraud is a coalition of

insurance Insurance is a means of protection from financial loss in which, in exchange for a fee, a party agrees to compensate another party in the event of a certain loss, damage, or injury. It is a form of risk management, primarily used to hedge ...

organizations, consumers, government agencies and legislative bodies working to enact anti-

fraud In law, fraud is intentional deception to secure unfair or unlawful gain, or to deprive a victim of a legal right. Fraud can violate civil law (e.g., a fraud victim may sue the fraud perpetrator to avoid the fraud or recover monetary compens ...

legislation, educate the public, and provide anti-fraud advice.Brostoff, Steven. “New Anti-Fraud Coalition Formed”. National Underwriter Property & Casualty-Risk & Benefits Management Journal, 1993, p. 46. They are also a resource where

consumer A consumer is a person or a group who intends to order, or uses purchased goods, products, or services primarily for personal, social, family, household and similar needs, who is not directly related to entrepreneurial or business activities. T ...

s can find scam warnings, learn where to report fraud, and how to protect themselves. The Coalition was founded in 1993 after several

organization An organization or organisation (Commonwealth English; see spelling differences), is an entity—such as a company, an institution, or an association—comprising one or more people and having a particular purpose. The word is derived from ...

s reported a heavy rise in insurance fraud and a need to stop it.

History

In 1993,

insurance fraud Insurance fraud is any act committed to defraud an insurance process. It occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due. According to the ...

investigators staged several bus crashes in

New Jersey New Jersey is a state in the Mid-Atlantic and Northeastern regions of the United States. It is bordered on the north and east by the state of New York; on the east, southeast, and south by the Atlantic Ocean; on the west by the Delaware ...

. The only passengers in the busses were

investigators. After the crash, they received over 100 claims from people who jumped on the bus after it crashed or simply drove by the scene and wanted to claim

money saying they were injured. In response to this problem, seventeen organizations formed The Coalition Against Insurance Fraud, contributing $500,000 to finance anti-fraud efforts. At the time, The Coalition estimated that auto fraud cost over $8 billion a year in overpaid claims. Since then, The Coalition has grown to include over 90 members, including

GEICO The Government Employees Insurance Company (GEICO ) is a private American auto insurance company with headquarters in Chevy Chase, Maryland. It is the second largest auto insurer in the United States, after State Farm. GEICO is a wholly owne ...

, National Consumers League, First Acceptance Corp., Healthcare Insight, Property Casualty Insurers Assoc. of America, SAS Institute, Thomson Reuters, Nationwide, and the Virginia State Police.

Mission

The Coalition's main mission is to fight

. The Coalition seeks to unite and empower private and public groups against

. Members work to control insurance costs, protect public safety, and reduce crime.
Three main areas of activity are: Government Affairs * To enact stronger anti-fraud laws through local and grassroots campaigns * Create model bills. For example, establishing insurance fraud as a specific crime.
* Strengthen anti-fraud bills * Hold major summits * Support prosecutions Communication * Raise public awareness of insurance fraud, and how public can fight back * Empower and alert consumers * Unite outreach efforts Research * Sponsor major research and surveys

Publications

* Journal of Insurance Fraud in America (JIFA), a quarterly publication containing in-depth analysis of trends, research, and public policy issues that may impact anti-fraud efforts * FraudWire, two quarterly digital publications reporting on important developments involving legislative activity and public awareness * Fraud News Weekly, a paid digital publication summarizing weekly trends on legislative and regulatory developments, state and federal court decisions, public outreach and media coverage, the week's fraud arrests, the latest convictions for insurance fraud, civil cases, administrative actions, upcoming meetings, seminars & conferences. * Get a Grip on Fraud: Fraud Awareness Manual, an action guide for creating memorable fraud-awareness events

Research

The Coalition has published several research studies over the past decade. Among them: * Effectiveness of warnings on benefit checks, in 2000, selected insurance companies writing workers compensation coverage in the United States were surveyed to determine their experience and perceptions with printed warnings on the back of benefit checks. * Four faces: why Americans do and don't tolerate fraud, to understand why people accept fraud, and why individuals sometimes won't report fraud even though they understand fraud raises everyone's premiums. Study includes focus groups and statistical survey. conducted to gain insight on why public tolerance of insurance fraud seems to be increasing. Both qualitative and quantitive research was used to attempt to understand how public attitudes about fraud are formed and what factors influence them. * Insurer fraud measurement, a survey completed by 65 Special Investigative Unit managers, mostly from property/casualty insurers, on their practices involving measuring anti-fraud activities for case referrals, fraud savings and performance evaluations of investigators. * Prescription for Peril, examining unreported and elusive aspects of

drug diversion Drug diversion is a medical and legal concept involving the transfer of any legally prescribed controlled substance from the individual for whom it was prescribed to another person for any illicit use. The definition varies slightly among different ...

, the role insurance fraud pays in financing

prescription abuse In the United States, prescription monitoring programs (PMPs) or prescription drug monitoring programs (PDMPs) are state-run programs which collect and distribute data about the prescription and dispensation of federally controlled substances and, ...

, and the high cost to insurers and consumers. * Special Investigative Unit study, conducted to learn how insurers measure the performance of their Special Investigative Units. A review of the measurement systems of 52 insurers found there is little consistency from insurer to insurer in the methods they use in their performance systems. * State Insurance Fraud Bureau Survey, a snapshot of state agencies’ fraud fight by the numbers, aimed at understanding the structure, responsibility, and overall activity of

across the United States

Fraud Warnings

The Coalition issues scam alerts for common schemes, elaborating on variations and best measures for prevention and defense. Among the topics: * Agents and insurers: Though most insurers and agents are honest, the Coalition warns against agents who pocket their clients' premiums, sell insurance that is fake or unnecessary, or provide unneeded coverage to boost premiums. *

Airbag An airbag is a vehicle occupant-restraint system using a bag designed to inflate extremely quickly, then quickly deflate during a collision. It consists of the airbag cushion, a flexible fabric bag, an inflation module, and an impact sensor. Th ...

s: Counterfeit airbags have been flooding the markets and posing a deadly threat to innocent motorists. * Auto repairs: Auto repair scams have been known to involve purposely damaging cars in order to inflate repair costs, padding existing repairs, or cutting corners by doing low-quality work. * Bogus health plans: A tough economy can make individuals more vulnerable to buying too-good-to-be-true insurance plans * Contractors & adjusters: The Coalition warns against fraudulent contractors who appear after natural disasters to offer repairs, fraudulent contractors may add damage to increase costs, illegally lower deductibles, receive pay and disappear, or do work without a license. * Dental: Dental schemes often involve billing for treatment that was never provided, or providing treatment that was not needed * Discount medical cards: these cards offer discounted medical treatment or pills, but fake cards may provide no coverage or discounts * Drug diversion. The abuse of prescription drugs. * Medical identity theft: Medical identity schemes involve stealing someone's social security number, medicare number, medicaid number, and other identifying information in order to file insurance claims on their behalf for illegal gain. * Staged auto crashes: The Coalition warns against people who claim nonexistent injuries after crashes in order to exploit their insurance coverage, fraudsters may purposely crash into unsuspecting drivers, or stage a crash that is entirely set-up in person or on paper. *

Workers' compensation Workers' compensation or workers' comp is a form of insurance providing wage replacement and medical benefits to employees injured in the course of employment in exchange for mandatory relinquishment of the employee's right to sue his or her emp ...

: The Coalition warns against employers who do not purchase adequate coverage for their employees, and employees who fake injuries for paid time off.

References

External links

*{{Official website, http://www.insurancefraud.org, Coalition Against Insurance Fraud
Investment Fraud Fund Recovery
Consumer fraud Fraud in the United States 1993 establishments in the United States Insurance fraud