Suspected Fraud Referrals

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Transcription:

Suspected Fraud Referrals CASE TYPE FY 10/11 FY 11/12 FY 12/13 % increase/ decrease Personal Injury Protection 6699 7748 7346-5% Workers Compensation 1495 1388 1733 25% Vehicle 1008 1167 1390 19% Application 883 974 1227 26% Licensee 765 704 905 29% Homeowners 584 663 765 15% Healthcare 486 426 536 26% Commercial 404 451 411-9% Banking and Securities 287 590 356-40% Duplicate Entry 272 359 188-48% Disability 81 180 142-21% Arson for Profit 152 124 122-2% Financial Investigation 94 109 79-28% Non-Insurance Fraud 15 25 55 120% Other Agency Assistance 21 32 39 22% Life Insurance 35 37 33-11% Identity Theft 20 37 30-19% Unauthorized Entity 64 45 24-47% Warranty 19 14 18 29% Information Only 22 28 15-46% Marine 30 23 13-43% Title Fraud 8 11 11 0% My Safe Florida Home 6 3 6 100% Bonds 1 2 0-100% Referrals 12,084 12,820 13,452 15,141 15,447 FY 2008/2009 FY 2009/2010 FY 2010/2011 FY 2011/2012 FY 2012/2013

Presentations CASE TYPE FY 10/11 FY 11/12 FY 12/13 % increase/ decrease Personal Injury Protection 429 526 802 52% Workers' Compensation 336 352 475 35% Licensee 103 50 86 72% Vehicle 56 42 58 38% Homeowners 44 41 50 22% Healthcare 50 73 39-47% Disabilty 16 25 38 52% Application 48 29 34 17% Commercial 23 31 26-16% Other Agency Assistance 4 12 16 33% Marine 3 3 15 400% Arson for Profit 5 4 10 150% Financial 25 14 7-50% Banking and Securities 58 23 4-83% Warranty 2 0 4 n/a Identity Theft 1 2 3 50% Life Insurance 7 3 2-33% Title Fraud 2 7 1-86% My Safe Florida Home 1 1 0-100% Unauthorized Entity 2 4 0-100% Presentations 1,670 1,234 1,214 1,242 982 FY 2008/2009 FY 2009/2010 FY 2010/2011 FY 2011/2012 FY 2012/2013

Arrests CASE TYPE FY 10/11 FY 11/12 FY 12/13 % increase/ decrease Personal Injury Protection 352 496 651 31% Workers' Compensation 271 274 418 53% Licensee 70 151 141-7% Vehicle 56 41 57 39% Other Agency Assist 26 40 56 40% Healthcare 38 60 43-28% Homeowners 30 35 41 17% Disability 14 15 35 133% Application 40 28 34 21% Commercial 16 27 27 0% Banking and Securities 38 30 23-23% Financial 29 10 14 40% Arson for Profit 3 5 11 120% Life Insurance 3 1 6 500% Marine 2 5 4-20% Warranty 2 0 4 Identity Theft 1 3 3 0% Title Fraud 3 5 2-60% Unauthorized 1 2 1-50% Bonds 0 0 0 My Safe Florida Home 1 0 0 Arrests 1,571 1,288 834 1,042 997 FY 2008/2009 FY 2009/2010 FY 2010/2011 FY 2011/2012 FY 2012/2013

Convictions CASE TYPE FY 10/11 FY 11/12 FY 12/13 % increase/ decrease Personal Injury Protection 295 355 442 25% Workers' Compensation 242 208 259 25% Licensee 49 55 138 151% Vehicle 73 32 44 38% Healthcare 27 33 43 30% Homeowners 34 27 26-4% Disability 18 11 26 136% Commercial 17 12 25 108% Application 28 32 19-41% Other Agency Assistance 4 17 18 6% Financial Investigation 19 9 13 44% Banking and Securities 8 37 6-84% Life Insurance 4 1 5 400% Title 12 6 4-33% Arson for Profit 5 3 4 33% Identity 5 1 3 200% Marine 0 3 2-33% Unauthorized Entity 1 3 1-67% Warranty 1 0 1 Bonds 0 0 0 My Safe Florida Home 1 0 0 Convictions 1,079 840 845 706 532 FY 2008/2009 FY 2009/2010 FY 2010/2011 FY 2011/2012 FY 2012/2013

Suspected Fraud Referrals Personal Injury Protection Workers Compensation Vehicle Application Licensee Homeowners Healthcare Commercial Banking and Securities Duplicate Entry Disability Arson for Profit Financial Investigation Non-Insurance Fraud Other Agency Assistance Life Insurance Identity Theft Unauthorized Entity Warranty Information Only Marine Title Fraud My Safe Florida Home Bonds Homeowners, 765 Licensee, 905 Application, 1,227 Healthcare, 536 Vehicle, 1,390 Workers Compensation, 1,733 Personal Injury Protection, 7,346

Presentations Personal Injury Protection Workers' Compensation Licensee Vehicle Homeowners Healthcare Disabilty Disabilty, 38 Healthcare, 39 Homeowners, 50 Vehicle, 58 Application Commercial Other Agency Assistance Licensee, 86 Personal Injury Protection, 802 Marine Arson for Profit Financial Workers' Compensation, 475 Banking and Securities Warranty Identity Theft Life Insurance Title Fraud My Safe Florida Home Unauthorized Entity

Arrests Personal Injury Protection Workers' Compensation Licensee Vehicle Other Agency Assist Healthcare Homeowners Disability Application Commercial Banking and Securities Other Agency Assist, 56 Vehicle, 57 Licensee, 141 Disability, 35 Homeowners, 41 Healthcare, 43 Personal Injury Protection, 651 Financial Arson for Profit Life Insurance Marine Warranty Workers' Compensation, 418 Identity Theft Title Fraud Unauthorized Bonds My Safe Florida Home

Convictions Personal Injury Protection Workers' Compensation Licensee Vehicle Healthcare Homeowners Disability Commercial Homeowners, 26 Healthcare, 43 Disability, 26 Application Other Agency Assistance Financial Investigation Banking and Securities Vehicle, 44 Licensee, 138 Personal Injury Protection, 442 Life Insurance Title Arson for Profit Identity Marine Workers' Compensation, 259 Unauthorized Entity Warranty Bonds My Safe Florida Home

STAT PACK From 7/1/2012 To 6/30/2013 11:59:59 PM ADMINISTRATIVE Presented for EXTRA DUTIES PERFORMED 1 0 0 0 0 0 1 0 0 0 0 0 0.01% 0.00% 0.00% 0.00% 0.00% 0.00% APPLICATION FRAUD Presented for BY CLAIMANT 1 0 0 0 0 0 COMMERCIAL 7 2 2 0 0 0 CREDIT LIFE 1 0 0 0 0 0 DISABILITY 33 2 2 1 1 0 FINANCIAL 1 0 0 0 0 0 HEALTH 41 6 4 4 4 3 HOMEOWNER/SINKHOLE 0 3 2 1 1 0 HOMEOWNERS 55 4 9 4 4 3 HOMEOWNERS/SINKHOLE 2 0 0 0 0 0 HOMEOWNER-SINKHOLE 10 0 0 0 0 0 LIFE 212 6 9 2 3 1 VEHICLE 860 68 42 21 20 11 VESSEL 4 3 2 1 1 1 1227 94 72 34 34 19 7.94% 3.89% 3.41% 2.04% 2.16% 1.76% ARSON FOR PROFIT Presented for COMMERCIAL 4 2 2 1 2 0 HOME 30 4 9 5 5 3 VEHICLE 87 8 2 4 4 1 VESSEL 1 0 0 0 0 0 122 14 13 10 11 4 0.79% 0.58% 0.62% 0.60% 0.70% 0.37% AVIATION FRAUD Presented for FICTITIOUS CLAIM 2 0 0 0 0 0

2 0 0 0 0 0 0.01% 0.00% 0.00% 0.00% 0.00% 0.00% BANKING AND SECURITIES Presented for BANK FRAUD 1 0 0 0 0 0 FINANCE FRAUD 15 10 1 0 18 0 MORTGAGE FRAUD 337 3 13 4 5 6 SECURITIES FRAUD 3 0 0 0 0 0 356 13 14 4 23 6 2.30% 0.54% 0.66% 0.24% 1.46% 0.56% COMMERCIAL Presented for AGRICULTURE/LIVESTOCK 1 0 0 0 0 0 FICTITIOUS CERTIFICATE OF INS 18 7 3 7 5 4 FICTITIOUS CLAIM OR DAMAGE 54 6 11 2 3 2 FICTITIOUS LIABILITY CLAIM 99 4 7 1 2 3 INFLATED CLAIM 30 5 3 1 3 1 SLIP & FALL 209 18 26 15 14 15 411 40 50 26 27 25 2.66% 1.65% 2.37% 1.56% 1.72% 2.32% DISABILITY FRAUD Presented for FICTITIOUS CLAIM 107 33 29 34 31 23 WORKING WHILE COLLECTING 35 8 12 4 4 3 142 41 41 38 35 26 0.92% 1.69% 1.94% 2.28% 2.23% 2.41% DUPLICATE ENTRIES Presented for DUPLICATE 188 0 0 0 0 0 188 0 0 0 0 0 1.22% 0.00% 0.00% 0.00% 0.00% 0.00% FINANCIAL INVESTIGATION Presented for FINANCIAL 79 19 32 7 13 12 MORTGAGE FRAUD 0 0 1 0 1 1

79 19 33 7 14 13 0.51% 0.79% 1.56% 0.42% 0.89% 1.20% HEALTHCARE Presented for BY PATIENT 74 29 37 33 33 35 BY PROVIDER 293 13 22 4 6 5 DENTAL HEALTHCARE FRAUD 73 4 6 0 0 0 DENTAL HEALTHCARE FRD BY CLAIMANT 3 1 0 0 0 0 DISABILITY 8 0 2 1 1 1 EMPLOYER POCKETING PREMIUMS 15 0 2 0 0 0 FICTITIOUS INSURANCE CARD 0 0 2 1 1 0 FICTITIOUS PROVIDER 10 1 2 0 0 0 OTHER MEDICAL PROVIDER 16 1 2 0 0 0 PATIENT BROKERING 1 1 1 0 0 1 PRESCRIPTION FRAUD 36 6 10 0 2 1 SERVICES BY UNLICENSED PERSON 7 2 1 0 0 0 536 58 87 39 43 43 3.47% 2.40% 4.12% 2.34% 2.74% 3.99% HOMEOWNERS Presented for COOKING/KITCHEN FIRE 1 1 1 0 0 0 FICTITIOUS CLAIM OR DAMAGE 324 67 57 28 25 16 FICTITIOUS LIABILITY CLAIM 12 1 2 0 0 0 FORGERY BY HOMEOWNER 18 6 4 6 5 1 FORGERY BY OTHER 3 0 0 0 0 0 FORGERY BY PUBLIC ADJUSTER 8 2 1 0 0 0 INFLATED CLAIM 295 33 28 12 8 7 PLUMBING/TRENCHING 46 5 0 1 1 0 SINKHOLE 22 1 5 3 2 2 WATER EXTRACTION 36 2 2 0 0 0 765 118 100 50 41 26 4.95% 4.88% 4.73% 2.99% 2.61% 2.41% IDENTITY THEFT Presented for

BY ENTITY 1 0 0 0 0 0 BY PERSON 29 4 4 3 3 3 30 4 4 3 3 3 0.19% 0.17% 0.19% 0.18% 0.19% 0.28% INFORMATION ONLY Presented for INFORMATION 0 1 0 0 0 0 INFORMATION ONLY 15 0 0 0 0 0 15 1 0 0 0 0 0.10% 0.04% 0.00% 0.00% 0.00% 0.00% LICENSEE FRAUD Presented for ADJUSTER 9 0 5 11 12 10 ADJUSTER-BROKEN PIPE 6 0 0 0 0 0 ADJUSTER-BROKEN TILE 2 0 0 0 0 0 AGENCY 65 3 5 1 1 1 AGENT 265 74 67 35 30 18 ANNUITY 12 2 6 1 1 4 BAIL BOND AGENT 32 14 12 12 11 1 CARRIER 105 1 2 0 0 2 FICTITIOUS CLAIM OR DAMAGE 1 0 0 0 0 0 HEALTH MAINTENANCE ORG 1 0 0 0 0 0 Public Adjuster 119 21 18 7 5 7 PUBLIC ADJUSTER/SINKHOLE 1 0 1 0 0 0 PUBLIC ADJUSTER-BROKEN PIPE 17 0 0 0 0 0 PUBLIC ADJUSTER-BROKEN TILE 8 0 0 0 0 0 PUBLIC ADJUSTER-KITCHEN FIRE 2 0 0 0 0 0 SERVICE WARRANTY COMPANY 2 1 0 0 0 0 THIRD PARTY ADMINISTRATOR 0 0 1 0 0 0 TITLE INSURANCE 8 3 6 4 4 4 UNLICENSED AGENT OR ADJUSTER 222 30 25 14 11 8 UNLICENSED CONTRACTOR 25 9 4 1 66 83 VIATICAL BROKER 1 0 0 0 0 0 VIATICAL PROVIDER 2 0 0 0 0 0 905 158 152 86 141 138

5.86% 6.53% 7.20% 5.15% 8.98% 12.79% LIFE INSURANCE FRAUD Presented for BENEFICIARY FORGERY 24 4 6 0 3 3 CREDIT LIFE 2 1 1 1 1 1 LIFE AND ANNUITIES 1 0 0 0 0 0 MURDER FOR PROFIT 1 1 1 0 0 0 QUESTIONABLE DEATH 5 2 0 1 2 1 33 8 8 2 6 5 0.21% 0.33% 0.38% 0.12% 0.38% 0.46% MARINE FRAUD Presented for FICTITIOUS CLAIM 9 4 2 13 2 2 INFLATED CLAIM 4 4 1 2 2 0 13 8 3 15 4 2 0.08% 0.33% 0.14% 0.90% 0.25% 0.19% MY SAFE FLORIDA HOME Presented for CONTRACTOR 2 1 1 0 0 0 HOME INSPECTOR 3 1 1 0 0 0 1 0 0 0 0 HOMEOWNER WIND RESISTANT IMPROVEMENTS 0 6 2 2 0 0 0 0.04% 0.08% 0.09% 0.00% 0.00% 0.00% NON-INSURANCE FRAUD Presented for INTRA-AGENCY RESPONSE LETTER 0 1 1 0 0 0 NO ACTION 55 0 0 0 0 0 55 1 1 0 0 0 0.36% 0.04% 0.05% 0.00% 0.00% 0.00% OTHER AGENCY ASSISTANCE Presented for AGENT 0 0 1 0 0 1 ASSISTANCE 39 38 39 7 41 9 UNLICENSED CONTRACTOR 0 3 0 9 15 8 39 41 40 16 56 18

0.25% 1.69% 1.89% 0.96% 3.56% 1.67% PERSONAL INJURY PROTECTION Presented for BY ATTORNEY 66 4 5 3 2 2 BY CLAIMANT 2336 148 110 109 89 63 BY PROVIDER 2906 143 138 167 120 73 FICTITIOUS CLAIM OR DAMAGE 1 0 0 0 0 0 FICTITIOUS INSURANCE CARD 308 132 101 75 74 53 ILLEGAL POSSESSION OF ACCIDENT 3 0 0 0 0 1 REPORT JUMP IN 201 64 48 44 34 23 LOST WAGES 18 6 4 4 3 4 PAPER ACCIDENT 50 11 10 33 25 20 PATIENT BROKERING 31 14 16 30 19 11 SOLICITATION 229 41 40 18 10 5 STAGED ACCIDENT 979 165 155 303 266 178 UNLICENSED ACTIVITY 218 15 8 16 9 9 7346 743 635 802 651 442 47.56% 30.72% 30.07% 48.02% 41.44% 40.96% RISK MANAGEMENT Presented for GOVERNMENT EMPLOYEE 0 0 1 0 0 0 0 0 1 0 0 0 0.00% 0.04% 0.05% 0.06% 0.06% 0.00% TITLE FRAUD Presented for HOME 3 2 2 0 1 4 PROPERTY 6 0 0 0 0 0 VEHICLE 2 1 0 1 1 0 11 3 2 1 2 4 0.07% 0.12% 0.09% 0.06% 0.13% 0.37% UNAUTHORIZED ENTITIES FRAUD Presented for HEALTH 5 0 1 0 0 1 LIFE AND ANNUITIES 2 1 1 0 0 0 MARINE 1 0 0 0 0 0

PROPERTY/CASUALTY 9 0 0 0 0 0 PROVIDER 0 0 0 0 1 0 VEHICLE 7 0 0 0 0 0 VEHICLE FRAUD 24 1 2 0 1 1 0.16% 0.04% 0.09% 0.00% 0.06% 0.09% ACCESSORIES 94 22 13 7 7 2 BODY SHOP 148 16 12 4 3 3 BY CLAIMANT 6 1 0 0 0 0 BY PROVIDER 1 0 0 0 0 0 DAMAGE TO VEHICLE 636 68 59 29 29 19 DITCHING 493 49 61 18 18 19 FAILURE TO RETURN (THEFT) 11 2 2 0 0 1 JUMP IN 1 0 0 0 0 0 VEHICLE 0 1 0 0 0 0 WARRANTY FRAUD 1390 159 147 58 57 44 9.00% 6.57% 6.96% 3.47% 3.63% 4.08% CELL PHONE 3 2 1 4 4 1 HOME 11 0 0 0 0 0 VEHICLE 4 0 0 0 0 0 WORKERS' COMPENSATION 18 2 1 4 4 1 0.12% 0.08% 0.05% 0.24% 0.25% 0.09% Presented for Presented for Presented for AGENT PREMIUM 2 2 3 1 1 0 BY ATTORNEY 2 0 1 0 0 0 BY EMPLOYEE CLAIMANT 590 191 196 60 48 48 BY EMPLOYER 84 39 29 23 17 7 BY PROVIDER 14 2 0 0 0 0 COMMERCIAL 0 1 1 1 1 1 EMPLOYEE PAYROLL DEDUCTION 6 3 4 0 0 0 EMPLOYER PREMIUM 132 42 23 39 29 8

FICTITIOUS CERTIFICATE OF EXEMPTION 3 0 2 1 0 1 FICTITIOUS CERTIFICATE OF INSURANCE 36 26 24 17 8 9 ID THEFT OF NUMBER OR NAME 433 291 215 147 154 97 LEASING COMPANY 4 1 1 0 0 0 MONEY SERVICE BUSINESS 0 13 1 6 3 0 UNLICENSED CONTRACTOR 0 1 0 1 1 0 VIOLATION OF STOP WORK ORDER 194 65 70 45 42 25 WORKING WITHOUT COVERAGE 233 214 134 134 114 63 1733 891 704 475 418 259 11.22% 36.79% 33.33% 28.38% 26.54% 24.00% Grand Total 15447 2419 2112 1670 1571 1079 10/18/2013 4:30:53 PM Page 1 of 1