‘Tis the season to be jolly, but beware, it’s also the season to be cheated. Unfortunately fraud scams seem to increase during the holidays, probably due to the benevolent spirit of most individuals. 

By nature I am a positive person and I try to think the best of people. But working with the Anti-Fraud Unit has shown me that not everyone tries to do the right thing. There are plenty of people who will steal, connive and cheat their way to easy prosperity.

I don’t often quote James Garfield, but I’m reminded about a story he told of running for president. During the campaign for the White House he agonized over the thought, “how am I going to get there?” After being elected he started asking himself a different question:  “How did all of these other people get here?”

I’ve started asking a similar question and wonder how people get conditioned to where it becomes almost routine for them to commit fraud. The most logical answer to that question is greed.

Here are a few examples of what happens to people who let greed get the best of them.

Too bad they didn’t consider the consequences before they decided to defraud someone else.

Photo of Randy BrogdonI look forward to providing Oklahoma consumers with an insurance fraud blog that can help them in their daily lives. Thanks for visiting, and come back often!

– Randy Brogdon, Deputy Commissioner of Fraud and Consumer Affairs

Long-running insurance scam soaks boat owners

The old saying, “you get what you pay for” is not always the case. Most of us have little reason to doubt whether the insurance policy we bought is legitimate. The reason for our trust is because the vast majority of insurance professionals are just that, professionals.

But in any industry there are some unscrupulous individuals who are willing to violate your trust and cheat you out of what is rightfully yours.  Such was the case when a tour boat operator discovered his insurance policy was fictitious, only after his boat sank and claimed the lives of 20 elderly tourists.

This scam went on for over 10 years throughout the United States and the West Indies. So far six have been charged in the scheme and only time will tell how many people have been bilked out of potentially millions of dollars.

The link to the article gives further details about the companies involved in this particular fraud scheme.  Please contact the Oklahoma Insurance Department if you have been affected in any way.

Photo of Randy BrogdonI look forward to providing Oklahoma consumers with an insurance fraud blog that can help them in their daily lives. Thanks for visiting, and come back often!

– Randy Brogdon, Deputy Commissioner of Fraud and Consumer Affairs

In Oklahoma, when damaging wind comes right behind the rain (or hail), contractor fraud often comes sweeping down the plain, as well

Oklahoma can only be fully appreciated by those of us who actually live here. Whether you reside in the city, a rural community or the countryside, Oklahoma is a great place to call “home.”

One thing for sure, if you live in Oklahoma any length of time, not only will you appreciate the benefits but you might experience the side effects of too much wind, rain and hail.

Storms and other natural disasters can strike at any moment which can cause financial devastation, especially if your property and casualty insurance is not in force. Natural disasters inflict billions of dollars of damage each year, causing consumers to pay more for their auto and homeowners insurance policies.

Unfortunately, a man-made catastrophe called fraud can strike at any time, particularly after a natural disaster and causing added havoc. Needless home repairs, roof replacements, fake accidents and other kinds of insurance scams contribute to a national annual loss estimated to be $30 billion.

The good news is you can avoid being a victim of contractor fraud simply by arming yourself with some “do” and “don’t” facts. The National Insurance Crime Bureau (NCIB) has provided some great advice on how to be protected from fraud.

Photo of Randy BrogdonI look forward to providing Oklahoma consumers with an insurance fraud blog that can help them in their daily lives. Thanks for visiting, and come back often!

– Randy Brogdon, Deputy Commissioner of Fraud and Consumer Affairs

Stopping Medicare waste rewards whistleblowers, benefits taxpayers

Being known as a tattletale usually isn’t very pleasant, but in this Medicare fraud case it was certainly profitable.  An Indiana company, while denying wrongdoing, has agreed to pay nearly $42 million to settle a government lawsuit that alleged Medicare fraud and more than $8 million will go to a pair of whistleblowers who helped with the government’s investigation.

According to the charges, Hill-Rom Holdings Inc. of Indiana, a medical equipment company, would automatically bill Medicare for “long periods of time … without making any reasonable effort to determine if the patients for whom it submitted the claims continued to meet Medicare conditions for payment.”

It’s alleged that payments were requested by Hill-Rom for patients who no longer qualified for it, including some who had died or were no longer using the equipment.

Whether or not the activity takes place in another state or here in Oklahoma, Medicare fraud, abuse and mismanagement affects all of us because Medicare is funded solely by American taxpayers.  As with many government programs, the larger they grow the less manageable they become.  The Medicare system is so vast that it can be years before mismanagement or fraud is detected.

Although most government programs begin with good the intentions of meeting specific needs of the public, too often they end up as just another wasteful program protected under the shroud of bureaucratic oversight. When any organization is too big to manage, it becomes ripe for all kinds for fraudulent activates.

The sheer number of patients eligible for Medicare inflates the potential of waste and fraud throughout the system. Often the fraud goes undetected for years costing the taxpayers millions of dollars. Thankfully, these two whistleblowers brought this case to a screeching halt, saving the taxpayers untold millions.

Photo of Randy BrogdonI look forward to providing Oklahoma consumers with an insurance fraud blog that can help them in their daily lives. Thanks for visiting, and come back often!

– Randy Brogdon, Deputy Commissioner of Fraud and Consumer Affairs

Dishonest docs seeking quick cash resort to ‘Rent-a-Patient’ scams

Greed is an excessive desire to possess wealth and Fraud is the intentional perversion of truth in order to unscrupulously gain something of value. The two go together like biscuits and gravy and are most often the root cause of insurance crime.

A most disturbing segment of insurance-related fraud is called “Rent-a-Patient.” This is where a doctor solicits an individual to undergo unnecessary surgery. I was shocked to learn that this scam existed, but even more shocked to learn that the recruits are often low-income immigrants and even their children.

Normally when surgery is performed the patient pays the doctor, but in this case the doctor pays the patient. That doesn’t make any sense until you exam the scam.

A closer look uncovers the reason why someone would consider undergoing unneeded surgery; the reason is greed. The ability to make some easy money is a temptation that is hard for some to resist.  Here is how the scam works.

A doctor finds a patient that could really use some extra money and convinces him that for a little discomfort and down-time, his financial troubles can be eased. The doctor for example, offers to pay the patient $1,500 for a colonoscopy and turns in a bill to the insurance company for twice that amount or even more. After all, a colonoscopy will be needed at some point, so they might as well get it over with now. It’s a win-win situation, right?

Wrong! It is as illegal as it is immoral.

Rent-a-Patient fraud adds a huge cost to insurance premiums thereby affecting policy holders as well as providers, not to mention the fact that it is just plain wrong.

Photo of Randy BrogdonI look forward to providing Oklahoma consumers with an insurance fraud blog that can help them in their daily lives. Thanks for visiting, and come back often!

– Randy Brogdon, Deputy Commissioner of Fraud and Consumer Affairs

Medicare fraud sweep nets 91; help us keep Oklahoma clean

Medicare fraud is a serious problem in the United States, and government regulators are responding with serious consequences.

Earlier this month, Attorney General Eric Holder and Health and Human Services Secretary Kathleen Sebelius announced a nationwide operation by the Medicare Fraud Strike Force with special focus on eight cities had resulted in charges against 91 defendants, including doctors, nurses and other medical professionals. All were accused of participating in Medicare fraud schemes that totaled some $295 million in false billing.

Suspects were collared in Miami, Houston, Dallas, Baton Rouge, La., Brooklyn, N.Y., Los Angeles, Detroit and Chicago.

“The defendants allegedly treated the Medicare program like a personal piggy bank,” said U.S. Assistant Attorney General Lanny A. Breuer.

While Oklahoma cities weren’t targeted in this Medicare fraud sweep, we know our state isn’t immune from Medicare fraud. Several Oklahomans have been caught and prosecuted for similar crimes, and more will be in the future. The lure of easy money creates incentive for some people to be dishonest.

 But we here at OID remain on watch for Medicare fraud, and we ask you to share our vigilance. If you suspect Medicare fraud, go online at smp.oid.ok.gov, e-mail our Senior Medicare Patrol, or phone toll-free, (888) 967-9100.

Medicare fraud costs taxpayers millions of dollars annually, and threatens the benefits available to seniors who deserve them. Help us identify and stop Medicare fraud.

Photo of Randy BrogdonI look forward to providing Oklahoma consumers with an insurance fraud blog that can help them in their daily lives. Thanks for visiting, and come back often!

– Randy Brogdon, Deputy Commissioner of Fraud and Consumer Affairs

Mortgage fraud: Exploiting the down market for illegal profit

Fraud comes in many different forms and is most prevalent in transactions involving large amounts of money. “Easy money” is a magnet to organized criminals and Kryptonite to the honesty of unscrupulous individuals.

The sad thing is many people don’t set out to defraud someone else; rather, they may just be looking for a good deal and get caught up in an illegal situation.

On Aug. 21, the Federal Bureau of Investigation reported mortgage fraud is a growing area of concern because it is often linked to organized crime. The main enticement for most fraudulent activity is to be the recipient of that “easy money,” or as the mobsters say, “I’ll make you a deal you can’t refuse. “

“Buyer beware” should be standard operating procedure if purchasing or selling a home in today’s down housing market. One of the growing areas of real estate fraud is found in “short” sales. A short sale occurs when a house is sold far below market value and the lender is asked to forgive part of the original loan. That scenario in and of itself is not illegal, but if a realtor and short-sale investor conspire to keep the prices below fair market value for their own financial gain, fraud has just occurred.

A short sale scam is when both the realtor and investor make a deal below market value without the lender’s knowledge. For example: A realtor receives an offer of $160,000 on a house that has a mortgage of $175,000. The Realtor calls his investor friend and asks him to submit a bid for $140,000 and never tells the lender about the offer for $160,000. The lender accepts the $140,000 offer from the investor. The investor in turn sells the house through his realtor friend for $160,000. They split the $20,000 profit and have committed mortgage fraud.

The old saying, “follow the money” is certainly applicable in this fast-growing “short sale” racket. Whether it is tied to organized crime or just another brother-in-law deal, fraud is fraud.

As long as the lender is aware of all details of the transaction taking place, mortgage fraud has not occurred. Making a profit is not a crime, but non-disclosure is a serious problem that should be avoided.

Photo of Randy BrogdonI look forward to providing Oklahoma consumers with an insurance fraud blog that can help them in their daily lives. Thanks for visiting, and come back often!

– Randy Brogdon, Deputy Commissioner of Fraud and Consumer Affairs



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