What are False Insurance Claims?

Donn Saylor

The filing of false insurance claims is a type of insurance fraud carried out with the intention of deceiving an insurance company. There are two main varieties of false insurance claims: health insurance and auto insurance claim fraud. It is estimated that in the United States alone, false insurance claims cost the typical household nearly $1,000 US Dollars (USD) every year in raised premiums.

Filing a false insurance claim is a form of fraud.
Filing a false insurance claim is a form of fraud.

There are several ways a false insurance claim is typically submitted. In most instances, the claim is an outright falsification of conditions or events. These deceptions can be entirely fake or extreme exaggerations of actual instances. Another common tactic is the utilization of split billing, which is primarily done in the health care industry. A service provider will submit a series of claims for different medical treatments when, in reality, the patient did not receive all of the treatments or the treatments were not of the exact nature the provider reported.

A business owner who sets fire to their place of business to collect insurance money has engaged in insurance fraud.
A business owner who sets fire to their place of business to collect insurance money has engaged in insurance fraud.

The health care industry is the chief source of false insurance claims. These can be committed on the part of either the patient or the provider. When a patient attempts to file a false claim, he or she might refuse to divulge any preexisting conditions in order to obtain care or state a dependent is covered for care when that dependent actually is not. The person may also refuse to divulge any preexisting conditions that may otherwise prohibit care or record inaccurate information on health insurance forms.

The health care industry is the chief source of false insurance claims.
The health care industry is the chief source of false insurance claims.

A provider can also file false insurance claims. The provider may submit a claim on behalf of a doctor who does not really exist, bill for more expensive treatments than the ones the patient actually received or treatments never provided, or diagnose and/or provide care for a treatment that is outside the provider's field of practice. Claims of these types sometimes result in providers being paid huge sums of money under false pretenses.

Billing for more expensive procedures than a patient has received is a type of insurance fraud.
Billing for more expensive procedures than a patient has received is a type of insurance fraud.

The auto industry is another major source of false insurance claim filing. There are two types of false claims that are typically filed within the industry: staged accidents and exaggerated accidents. In staged accidents, claimants will stage an elaborate setup in which they involve an innocent party, make the accident look like the other party's fault, then proceed to get as much money as possible from the innocent person's auto insurer. With exaggerated accidents, claimants make assertions that an accident was much worse than it actually was, resulting in higher degrees of car damage and/or bodily harm.

False insurance claims may involve staged accidents.
False insurance claims may involve staged accidents.

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