Top 10 Extreme And Biggest Insurance Frauds Ever paprradmin November 17, 2015 Finance Do you want to get your hands on a hefty sum of money without killing yourself from work? It is not only you who desires to have a large amount of money without working as much as you need too. Many people out there think that they can get money by doing something deceitful and get away with it. They pay their insurances and get their benefits, but some cases are just too good to pass that they commit to insurance fraud to get a bigger sum of money than they are entitled to do so. In fact, an insurance fraud is very common ever since the start of insurance businesses that one authority even estimated $80 billion dollars for the value of insurance frauds each year. When a human wants money, he or she can go beyond to an extent where it leads to a dangerous disaster. This is exactly when insurance frauds happen but some cases go so extreme that you just can’t imagine if humans could do such a thing? Today, we are here to tell you about such 10 extreme and biggest insurance scams that has ever happened in the history. But before that, there are few things you need to know. What Is An Insurance Fraud? An insurance fraud is an act performed with the intention of acquiring improper or fraudulent payment from an insurance company or the insurer itself denies giving what is due to the benefactor. It can either be that the claimant will try to get a benefit that he/she is not entitled to have or the insurance company will not give benefit that is due to an individual. There are a few people who will insurance for an accident or sickness that are completely untrue. Some will also insure their property for a specific amount that is greater than the amount of the specific property, which they will then destroy and make it look like an accident so that they can receive the insurance. In 2006 alone, it was estimated that people have taken $766 million from their insurance companies by actually doing this stuff. Hard Fraud vs. Soft Fraud Hard fraud occurs when it is someone’s intention to plan the accident or invent a loss and let his or her insurance company cover the amount of the damage. While soft fraud refers to the claimant’s ability to exaggerate the damages done to their property or themselves compared to the actual damage, so that they will be able to get a large amount from the insurance company compared to what was actually intended for them. Types Of Insurance Frauds Considering that there are a lot of insurance companies offering insurances covering different aspects of human life and properties, it is also as expected that there are several types of insurance frauds as well. Automobile insurance fraud: An automobile insurance fraud occurs when someone fakes a collision or death due to an automobile accident. Everything from the collision to fake police documents are made and passed to the insurance company to release the amount for the damages. It may also be considered as an automobile insurance fraud when a real accident happens and the person involve will exaggerate claims of the damages to his/her car as well as the effect of it on his/her health. Health insurance fraud: It is referred to as such because this is a fraud that is intentionally concealing, deceiving or misrepresenting health information to obtain insurance from the insurer. You might be surprised to know that it is not only the patients who are guilty of committing such frauds but their healthcare providers as well who can easily manipulate healthcare records on their end. Life insurance fraud: A life insurance fraud occurs when someone fakes his/her own death to claim the insurance. Sometimes the people committing a life insurance fraud will re-appear and claim that they have loss memory of the accident such as the case of John Darwin who disappeared and was thought to have died in a canoeing accident; or at other times they are seen on a different place using a different name and living a different life such as the case of British Government minister John Stonehouse. Property insurance fraud: Most common case of a property insurance fraud is arson. It is typically a fraud wherein the owner of the property intentionally destroys the property to claim the insurance benefit or to obtain payment that is higher than the intended damage. 10 Of The Biggest Insurance Frauds… So Far Since insurance frauds are way too common and some people are literally making a living out of it (until they get caught, of course), we will never know when it will end or if it ever will. As insurance frauds are prevalent since the booming of insurance companies, here is a list of the top 10 biggest insurance fraud so far that will definitely make both your eyes bulge at the amount related to these frauds. 1. Medicare Fraud Strike Force ($712 million) The Medicare Fraud is by far considered as the largest healthcare fraud in history. The insurance company, Medicare Strike Force, filed a case against 243 healthcare professionals that include doctors, nurses, other licensed medical professionals as well as healthcare company owners for purportedly submitting a fraudulent bill amounting to $712 million. This case targeted 17 districts in 6 states which are California, Florida, Louisiana, Michigan, New York and Texas. The case filed involved several medical treatments and services such as psychotherapy, home health care, pharmacy, medical equipments, physical and occupational therapy frauds among others. More than 44 defendants were charge in relation to committing fraud through the prescription drug benefit program called Medicare Part D. All defendants were charge with healthcare fraud-related crimes such as violating the anti-kickback statutes, conspiracy in committing healthcare fraud, aggravated identity theft and money laundering. 2. Hospital Corporation of America Healthcare Fraud ($631 million) In the case of the Hospital Corporation of America (HCA), it was the insurer who committed a fraud against the consumers. The Hospital Corporation of America is actually a group of American hospitals that takes care of quite a number of Medicare cases since the 1990s. HCA lied to the amount that a person can claim from his/her medical assistance. Before everyone was able to check, they have already made a hefty $600 million from all of their fraudulent claims that were paid by US taxpayers. HCA was charged and they paid $2 billion in civil lawsuits but the damage has already been done. It made us aware that even our trusted insurance companies can make a fool out of us. 3. DaVita Healthcare Settlement ($450 million) DaVita Healthcare is a Denver-based dialysis service provider that had purposely devised a scheme with the drug companies that they are affiliated with and make use of the drugs that should have already been put into waste considering that it was the excess of another patient. The drugs Zemplar and Venoflar come in doses that are greater than what a doctor usually prescribes and the excess of the drug becomes a waste product. The company was able to plan and develop a dosing grid that enables them to use the only dose required by a certain patient and recycle the remaining excess to be use on another patient. However, the healthcare provider still charges Medicare for the price of both the dose and the “waste”. 4. National Heritage Insurance Company and Sholam Weiss ($450 million) Recorded as the largest collapse of an insurance company because of Fraud, Sholam Weiss and his accomplices were able to take $450 million out of the company. As a young man, Weiss was cunning. He bought a small plumbing supply company at the age of 20 years old and turned it into a million dollars business. With that amount of cunning and intelligence, Weiss made it negatively useful as he became a perfect con man. The owners of the National Heritage Life Insurance were pocketing the money of the company and they were in need of Weiss’s intelligent assistance and abilities. Working together, they were able to take the amount of $450 million from the National Heritage Insurance Company which resulted to the downfall of the said business. Weiss had become a fugitive but was later arrested and sentenced to 845 years in prison. That’s too many years to count. 5. Mikhail “Russian Mike” Zemlyansky ($275 million) Zemlyansky was considered as the poker-playing auto insurance fraudster. His case was considered as the largest no-fault auto insurance fraud scheme that amounted to a staggering $275 million. Russian Mike as he is fondly called, he employed a number of doctors and lawyers to orchestrate the fraud. He then filed for multiple claims for unnecessary procedures and tests. He and his accomplices swindled the insurers for more than a $100 million. Aside from the automobile insurance fraud that he committed, he also operated two investment companies that took $18 million from its investors. In addition to all of his crimes, he also organized high-stakes illegal poker games at Mill Basin. With all of these unlawful schemes and acts, it is no question that Zemlyansky is sentenced to over 100 years in prison. 6. National Medicare Scam and Fake HIV Clinics ($250 million) Another national Medicare fraud that were committed by the healthcare professionals that we trust the most, it involved and cost our country millions of dollars just for what? Fake HIV clinics that did not even help its patients in any way? This fraudulent scam involved a lot of major cities which even made way for the development of fake HIV clinics in Detroit. When everything became clear, the individuals who committed fraud were all persecuted and the fake clinics were shut down. 7. Tuomey Healthcare System ($237 million) Filed against a non-profit hospital in a rural community that is considered as medically under-served area by the South Carolina US Court of Appeals under the False Claim Act as well as the Stark Law, this insurance fraud is considered as the largest amount to have been given to a community hospital. As a matter of fact, the fine given to them exceeded the hospital’s annual profits. It was found out that the hospital submitted 21,730 fake claims for reimbursement to Medicare to which the district court gave a fine totaling to $237,454, 195 for the damages and civil penalties. 8. Liberty National Insurance and Martin Frankel ($200 million) Martin Frankel was tried and jailed for his crimes about insurance frauds as well as prostitution. He bought several insurance companies and used these companies to scam the innocent policyholders. He advertised to give the policyholders better returns but instead placed the money inside his own pockets. He also pacified other people with false reports until the authorities were alerted of his doings. It was found out that Frankel only use the Liberty National Insurance as a front for his crimes as he was able to bilked people out of $200 million. 9. Unity Outpatient Surgery Center Health Insurance Scam ($154 million) The Unity Outpatient Surgery Center Health Insurance scam is probably one of those scams that actually involved thousands of people. In this scam, it has been found out that a certain group of people recruited more than 2,500 healthy individuals to undergo an operation. Though they are healthy and without any underlying medical conditions, they were convinced to undergo surgeries that they do not need in exchange of cash payments. When the authorities were alerted, a number of surgery centers were charged with fraud though it already took $154 million from the medical insurance companies that they have targeted. 10. Dr. Munir Uwaydah ($150 million) When we get sick, we run to our medical physicians to help make us feel better. But some physicians are just not to be trusted just like Dr. Munir Uwaydah who was filed with $150 million insurance fraud. It has been found out that the doctor had his assistants do surgical procedures on his patients even without proper medical training. While the surgeries were conducted, it was claimed that the doctor was not there to supervise the operation. They placed the patients under general anesthesia and made them believe that it was Dr. Uwaydah who performed the surgical procedure since the surgeries were also billed to insurance companies under the doctor’s name. There were a total of 15 defendants on this case including the doctor himself, his personal lawyer as well as his previous office manager.