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
(A) Honda C) Hyundai
(B) Chevrolet D) Audi
(C) Hyundai, specifically Elantra and Sonata models
Despite the name, this describes a protection given to contractors, suppliers, and other laborers in the form of a lien on a property which has been improved.
What is a MECHANIC'S LIEN?*
Fun fact: Thomas Jefferson intro'd this concept to America in the early 1800's, to encourage settlement of the continent further west.*
*link to source in slides
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)?
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)
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%*
*according to the National Association of Insurance Professionals
'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?
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"
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
What is a BLOCK POLICY?
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?
A common tool in the insurance industry, this software is designed to manage, store, and analyze customer interactions and data collected throughout their time with the business. Aiming to enhance customer satisfaction and drive business growth, these systems are abbreviated to "CRM," which stands for what?
Answer: Customer Relationship Management [system]
This type of insurance policy covers movable property, (usually valuables, art, jewelry, rare stamps, etc.), whatever its location, within the territorial limits set by the insurance contract.
What is a FLOATER [insurance] policy?
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?
HINT: "MM"
What is 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. Please name 2 examples of protected health information (aka, what info would disclosing without permission violate HIPAA?)
Examples:
-individual's:
-name -date of birth
-address -social security number
"Durable Medical Equipment" is covered under Medicare, but to qualify, the item must be (1) durable (aka re-usable), (2) used for a medical purpose, (3) useful to a sick or injured person, (4) used in the home, and finally, must have an estimated lifespan of at least:
(A) 1 year (C) 6 months
(B) 3 years (D) 18 months
(B) 3 years