Insurance fraud is a big deal, and unfortunately, it’s a growing problem. According to statistics, non-medical insurance fraud costs more than $40 billion each year. When including medical insurance fraud in the numbers, the total is closer to $80 billion yearly.
Recently, several New York attorneys and doctors have been charged with insurance fraud for fraudulently acquiring more than $31 million from insurance companies. According to Justice.gov, four people have been indicted on charges of conspiracy to commit mail and wire fraud through staging fraudulent trip-and-fall accident cases.
Those indicted include George Constantine, Marc Elefant, Andrew Dowd, and Sady Ribeiro. All four have been accused of engaging in insurance fraud dating all the way back to January 2013, that continued until April 2018. Their trip-and-fall scheme went undetected until August 2021.
Not surprisingly, in 2015, some of the people involved in the scheme branched off to start their own fraudulent schemes. Throughout the time of both schemes, they managed to recruit over 400 people to pretend to trip and fall at various locations throughout New York City.
Trip-and-fall accidents must involve negligence
It seems hard to believe that anyone could carry on a scheme for that long, considering trip-and-fall accidents require proving negligence. For example, a victim (fake victim in this case) must prove that the business or city had a duty to act in a way that would have prevented the accident. However, they chose easy targets like cracked sidewalks and potholes – things most cities and businesses fail to repair.
These criminals went above and beyond with their deception
Unlike some insurance fraudsters, this particular set of criminals went above and beyond to make their staged accidents look legitimate. Even insurance companies didn’t catch on to the scheme.
For example, after the staged accidents, the fake victims were told they would need to seek specific medical care from the doctors involved in the scheme. They would go to medical and chiropractic appointments and would then be recommended for surgery.
Shockingly, these fake victims were willing to undergo multiple surgeries, all for just a little bit of money. For instance, one victim underwent arthroscopic surgery on their shoulder that was completely unnecessary. Others went through multiple surgeries. In the end, they received a small stipend while the doctors received the lion’s share of the insurance money.
These fraudsters preyed on vulnerable people to play the part of the victim. They recruited drug addicts, homeless people, and people who could barely afford warm clothes and food. It was stated that some of the fake victims would ask for food when meeting with the attorneys.
Insurance fraud is an easy target for criminals
If you’re wondering why so many people commit insurance fraud, it’s because it’s an easy target. That doesn’t mean it’s easy to get away with – on the contrary. Many insurance fraud schemes are uncovered quickly and don’t make it through the legal system. However, some schemes are more complex and well thought out, and only get discovered when someone spills the beans.
Fraudsters have to take a big risk when launching an insurance fraud scheme. Each person they bring into their scheme has the potential to ruin everything. That’s why they mainly prey on the most vulnerable people in the population – people who are desperate enough to accept low payouts and people who wouldn’t have the knowledge or energy to report the crime in the first place.
Insured property is also a common target for fraud
These days you can insure just about everything you own from your musical instruments to your wedding ring. While property insurance makes sense for some people, it’s not always worth the cost. For instance, if someone owns a rare guitar, but it’s in terrible condition, it doesn’t make financial sense to insure that guitar. However, a fraudster will see that as an opportunity to cash in on their insurance policy.
When a fraudster owns a valuable item that is insured, but that item is in terrible condition (or it’s worth less than the insurance policy states), they have all the incentive needed to destroy the property intentionally and collect on their policy.
Insurance fraud is never worth the payout
No matter how good the payout seems, it’s never worth committing fraud. Don’t let yourself get caught up in a fraudster’s scheme. It hurts everyone involved, including you, your family, innocent businesses, and makes it harder for real victims to get justice through the legal system.