Sunday, November 14, 2010

Fraud Signals

How can you tell if someone is being dishonest?  Perhaps you could test them by asking the right questions to "catch" them or perhaps you could look for visual cues that the person is experiencing some anxiety about lying.  As an investigator the first step in determining if someone is being dishonest is to find out how that dishonesty may benefit them.  In the case of insurance fraud, that is usually pretty simple as there is some monetary gain to be had.  Creative perpetrators however will create something that I like to refer to as a "dishonesty sandwich".  This is the creation of a story that has layers and layers of truth and lies mixed together.  Sometimes a collection of small lies is stuffed in between some large and undeniable truths.  This method of "stacking" issues together can work to pad claims or to embellish injuries, adding value to the final claim payment. 

Very often we see injury claims that have volumes of medical reports attached, making the injury appear to be severe.  Often however, we find that the legitimate injury that really did get medical attention (the large undeniable truth) was resolved very early on and the lion's share of all the paperwork in the file is follow up and re-hashing old reports.  Are these reports lies?  Not really.  This dishonesty occurs when those reports are collected and submitted as evidence of a "severe" injury.

When the clamp starts to close and the dishonesty becomes evident, perpetrators will often attempt to change the focus to the back to the undeniable true components of their story to garnish sympathy from those unfamiliar with the full facts of the case.


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