National Trends & Current Challenges:
What is fraud?
TRUE or FALSE:
Intentionally providing false information for an insurance claim is NOT fraud if no service ends up being provided?
FALSE
This is the amount of a loss a policyholder agrees to pay (per claim or per accident), toward the total amount of an insured loss.
The cost of a given unit of insurance, on which the premium amount is based, is known as what?
What is RATE?
Neb. Rev. Stat. 44-393 identifies 5 total groups that are required to report any instance of fraud or violation of the law to the NE DOI - name two (2) groups
Answer: 1) Insurance companies, 2) agents, 3) brokers, 4) insurance solicitors, 5) any person/party with knowledge of fraud/violation
According to data from the National Insurance Crime Bureau (NICB), which brand of vehicle was the most stolen in 2024?
(A) Honda C) Hyundai
(B) Chevrolet D) Audi
(C) Hyundai, specifically Elantra and Sonata models
In the auto realm, "staged-crash" rings injure or kill innocent victims and cost auto insurers billions of dollars a year. What is the most common, and hardest-to-refute "phantom injury" resulting from these staged car crashes? [Or, provide an example of this kind of injury]
What is "SOFT-TISSUE INJURY",
Examples: Whiplash, back injuries, sore back
A crime as old as government, this word describes the fraudulent use or taking of another's property or money, which had been entrusted to one's care.
What is EMBEZZLEMENT?
What federal law, passed in 2010 and effective 2013, created the Health Insurance Marketplace, aka the Health Insurance Exchange?
Full name or acronym
What is the AFFORDABLE CARE ACT (ACA)?
There are multiple ways to report insurance fraud, both at the state and national level; Name two entities that accept and investigate claims of insurance fraud.
(A) National Insurance Crime Bureau (NICB)
(B) the NAIC's OFRS (Online Fraud Reporting System)
(C) Nebraska Department of Insurance's consumer complaint hotline/website
According to the NAIC, on average, what % of every $ spent on insurance premiums does insurance fraud cost the average consumer?*
(A) 5% (B) 20% (C) 50% (D) 35%
What is (B), 20%
'Inland Marine' insurance covers goods in transit, as well as the vehicles carrying them, but ironically does not cover transport across what?
What is the ocean?
or - usually, does not cover trans-ocean cargo or vessels
Commonly nicknamed "insurance for insurance companies," what is the term for the assumption by one insurance company of some or all of the risk(s) of another insurance company?
What is RE-INSURANCE?
Medicaid is a federal program, meaning it applies to all fifty states. What is the States' primary tool in Healthcare law enforcement?
i.e., name the state-level entities who investigate/enforce federal healthcare
What are "MEDICAID FRAUD CONTROL UNITS"*
*Depending on the state, these units may possess civil & criminal authority; Nebraska's MFCU investigated 13,528 complaints related to Medicaid fraud [see "links" slide for source]
The mission of NE Insurance Fraud Prevention Division is to confront the problem of insurance fraud in Nebraska, in an effort to reduce the amount of premium dollars used to pay fraudulent claims. What are two ways this is accomplished?
HINT: "P.I.P."
Answer: by prevention, investigation, and prosecution of fraudulent insurance acts in the state.
TRUE or FALSE:
In the context of MedicAID, fraud committed by health-care RECIPIENTS is more of an issue than fraud committed by health-care PROVIDERS?
False*
*according to a study from Georgetown University; link in slides
Hurricanes, tornadoes, floods, hail and other rough weather cause damage to homes every year. Most contractors are honest, yet some want to line their pockets at your expense. What term describes a lawful contract/agreement used by dishonest contractors to facilitate fraud against consumers and insurers?
What is an ASSIGNMENT OF BENEFITS, or AOB
Frequently abbreviated, this term describes the cost of repairing/replacing damaged property with property of the same kind, quality, and/or physical condition; or:
Replacement cost - (minus) depreciation = _____?
What is ACTUAL CASH VALUE (ACV)?
Commonly confused with insurance companies, these entities provide a sort of 'health-care subscription plan,' in which the customer pays them directly in order to receive certain medical services at a lower price
What is a DISCOUNT MEDICAL PLAN ORGANIZATION?
This technology is relatively new, but already causing significant changes to the insurance industry, among many others. What term refers to the development of computer systems capable of performing tasks like recognizing speech, making decisions, identifying patterns, and solving problems?
Answer: Artificial intelligence (AI)
Cargo insurance can be taken out on 'movable property,' and a large amount of cargo is reported as lost every year. On average, how much money is estimated to be lost in cargo theft each year -?
(A) $30 million (C) $30 billion
(B) $40 million (D) $1 trillion
What is (A) $30 million, per year
Which type of commercial insurance policy covers multiple motor vehicles (usually 5+), all owned by a single policyholder?
What is a FLEET POLICY?
The term for the willful (versus accidental) damaging or destruction to another person's property has what fun-to-say name, as well as a more common alias?
[either answer accepted]
HINT: "MM"
What is VANDALISM, or "MALICIOUS MISCHIEF"?
Under the Health Insurance Portability and Accountability Act (or, HIPAA), certain data is protected as "individually identifiable health information," meaning it can be used to identify an individual or their health records. Name 2 examples of protected health information
Examples:
-individual's:
-name -date of birth
-address -social security number
Pennsylvania's legislature recently passed a law making the use of these digitally-created false items to commit fraud or injure another person a felony offense.
HINT: example --> "voice clone"
Answer: "deepfakes"/ "false content generated by AI"