County of Montgomery,
Pennsylvania County of Montgomery,
Pennsylvania
Welcome
to the
Insurance
Fraud Unit
of the Montgomery County District Attorney's Office
What
is insurance fraud?
What
is the Insurance Fraud/Arson Unit (IFU)?
The
IFU was created in 1996 to identify, investigate and aggressively prosecute
those individuals and corporations committing insurance fraud in Montgomery
County. The IFU works closely with
local police departments, insurance companies and private citizens to help
identify and investigate insurance fraud. Where
appropriate, the IFU prosecutes those responsible for committing insurance
fraud. The IFU provides training to
law enforcement personnel, and educates the public as to insurance fraud.
The
IFU is also responsible for investigating arson in Montgomery County.
Insurance fraud and arson offenses are handled by one unit because arson
is often used as a means to commit insurance fraud.
Click here to review the Pennsylvania
arson statute.
The
IFU is dedicated to prosecuting all forms of insurance fraud.
Insurance fraud occurs with all types of insurance, including auto
insurance, health insurance, homeowners’ insurance, and workers’
compensation insurance.
●
Staged
accidents, when one or more individuals cause intentional collisions to receive
payments for vehicle damage.
●
Providing
false information to an insurance company about a car’s mileage, condition or
use.
●
Phony injury
claims, e.g., when people lie about suffering injuries in an accident.
●
Inflated
damage claims, e.g., when people falsify the true amount of damage incurred to
their vehicle or the amount repairs needed.
●
Phony thefts,
e.g., when the owner abandons a vehicle and then claims it was stolen.
●
Arson, e.g.,
when the owner intentionally burns his/her vehicle and then claims the fire was
an accident.
Health
Insurance Fraud
examples include:
●
Patients who
ask their doctors to falsify a report to an insurer to cover a non-covered
procedure.
● Patients who ask their doctors to waive co-payments.
●
Patients
forging receipts to get unwarranted reimbursement from an insurer.
●
Doctors
billing insurers for a more costly service than the one performed.
●
Doctors
providing services such as tests, surgeries or other procedures that are not
medically necessary to get additional payment.
● Doctors billing insurers for services not actually
rendered.
●
Doctors
billing each stage in a procedure as if each were a separate procedure.
●
Doctors
accepting “kickbacks” (i.e., payments) from other doctors for referrals.
Homeowners’
Insurance Fraud
examples include:
●
intentionally
burning one’s home (arson) and claiming an accidental loss.
●
staging a
phony burglary or vehicle break-in and claiming a loss.
●
overstating
the value of stolen items after an actual home or vehicle burglary.
●
lying about
the extent, cause, date or location of legitimate property damage.
●
making a
second claim for a loss that was already paid by another insurer or through a
prior claim.
●
asking a
repairman to “cover your deductible” within their estimate.
●
fabricating
supporting documentation – often in collusion with a contactor, plumber,
repairman or insurance adjuster.
Workers’
Compensation Insurance fraud
includes two types of fraud – claims fraud and premium fraud.
Examples
of claims fraud include a worker who:
● fakes an injury at work to get paid time off.
●
exaggerates
the severity of a legitimate injury to extend time away from work.
●
claims an
injury occurred on the job when it actually happened elsewhere.
Examples
of premium fraud include an employer who:
●
understates
the amount of company payroll to reduce premium payments.
●
claims employees are independent contractors.
●
classifies
employees with improper job codes that carry lower premiums.
●
Fails to
carry workers’ compensation insurance. Under
Pennsylvania law, all businesses employing one or more persons are required to
furnish workers’ compensation insurance for their employees.
How
do I report insurance fraud or arson?
You
may report insurance fraud or arson to your local police department.
Click here for a list of Montgomery
County police departments. You
may also report insurance fraud or arson directly to the IFU; your personal
information will be kept confidential.
●
By mail:
Office of the District Attorney
Insurance
Fraud Unit
P.O.
Box 311
Norristown, PA 19404-0311
●
By phone:
(610) 278-3132
●
By fax:
(610) 278-3095
●
By email:
slatzer@mail.montcopa.org
●
By website referral: referral
form
Why
should I report insurance fraud?
Because
insurance fraud is the crime that YOU pay for.
Losses sustained from insurance fraud are passed on to you, the consumer,
in the form of higher insurance premiums. Some
types of fraud, such as arson and staged accidents, actually place others in
physical danger.
Where
can I get more information about insurance fraud?
●
Pennsylvania
Insurance Fraud Prevention Agency
Created
by the Pennsylvania legislature in 1994 to combat all forms of insurance fraud.
Prosecutes
insurance fraud throughout the Commonwealth of Pennsylvania.
●
Pennsylvania
Department of Insurance
The
Commonwealth of Pennsylvania’s insurance regulation department.
●
National
Insurance Crime Bureau
Offers
extensive insurance information for consumers and insurers.
[Montgomery
County DA Home Page]
[Montgomery County Home Page]