Organized claims fraud can take many forms – PIP fraud, staged accident fraud, medical provider fraud and more. The thing they have in common is that they reflect criminal intent and generally involving recurring application and policy behaviors. Hence they can often be identified at POS – or at least pre-filtered so that important risks can be actively monitored during the policy lifecycle and at point of claim.
We also know that criminals often stage claims such that they are a little larger than the average claim, but individually small enough to avoid SIU notice. Indeed, they are often programmatic, recurring claims that follow a pattern of behavior that share one or more common elements– claims type, claims size, service provider, phone numbers, addresses, IP addresses and more. Identifying claims and policies that share these common elements is key to detecting, preventing and revealing these organized, serial frauds.
One possible combination of idFusion tools and services to identify them includes: