The investigation of insurance fraud in Japan

NEWS

Overview of insurance fraud and its methods


Insurance fraud is a serious crime that involves deceiving insurance companies to obtain benefits that are not rightfully owed. It can take many forms, including exaggerating claims, filing false claims, and staging accidents. However, one particularly insidious form of insurance fraud involves faking injuries or illnesses to collect on health insurance policies.

One common method of insurance fraud is exaggerating existing injuries or illnesses. For example, someone might claim that a minor sprain is causing them severe pain and require extended medical treatment, or they might claim that a mild illness is preventing them from working. Another common method is filing false claims for injuries or illnesses that never happened. This can involve claiming to have suffered a debilitating injury that never occurred, or claiming to have a chronic illness that they don’t actually have.

Insurance fraud involving feigned injuries and illnesses is a serious issue that undermines the integrity of the health insurance system and affects society as a whole.

Impact of Insurance Fraud on Society


Unwarranted insurance payouts resulting from health-related fraud have a significant negative impact on society. These fraudulent claims force insurance companies to disburse funds for fictitious or exaggerated medical conditions, ultimately leading to higher premiums for all policyholders. For example, Coalition against insurance fraud estimated in2022 that health insurance fraud costs the United States about $36 billion annually to possibility that affect healthcare costs for everyone. Moreover, these illegitimate payouts divert resources from genuine medical claims, potentially delaying or reducing care for those who truly need it. The ripple effect extends beyond the insurance industry, affecting the broader healthcare system by inflating costs and straining medical resources. In conclusion, unwarranted insurance payouts due to health-related fraud create a substantial financial and ethical burden on society, undermining the very purpose of health insurance as a system of mutual protection and care.

Insurance fraud investigations conducted by detectives

Detectives conduct insurance fraud investigations in the following ways.

Investigation of the subject’s behavior

The following is a survey of these procedures.Behavioral investigation is the investigation of a subject’s behavior by tailing or stakeout.Behavioral investigations are very effective in the investigation of insurance fraud. For example, if a person has been falsely claiming medical expenses due to an accident and fraudulently receiving insurance benefits, a behavioral investigation can reveal the actual condition of the hospital visits and injuries. If it becomes clear that there is no evidence of injuries or hospital visits, a case can be made for insurance fraud. In this case, photos and videos of the subject will be taken as evidence.
Specifically, we will conduct the following types of investigations

  • Monitoring access to the subject’s home
  • Surveillance of the subject’s visits to the hospital on the day of the visit
  • Monitoring the subject’s daily activities

    • Interview survey

    Interviews are an effective way to investigate whether or not an application is false.

    Interviews are conducted by collecting information from people involved in the fraud, people around it, and witnesses to the fraud to reveal the truth of the actual condition of the victim.

    With the eyewitness testimony, it may be possible to clarify the false application.

    Specifically, the following investigations are conducted

  • Interviewing target of the surrounding area
  • Checking the subject’s social networking sites

    • The reason these investigations are crucial is due to the sheer complexity and sophistication that characterize many insurance fraud schemes. Detectives are equipped with the expertise and resources necessary to dig deeper into claims, uncover evidence, and piece together discrepancies that typical reviews might overlook.

    There is a great distance between Japan and the U.S.. Therefore,　we also recognise that traveling to Japan for research can be challenging.We can conduct the research on your behalf.

    Case study of insurance fraud investigation by our company


    An insurance company asked our company to conduct an investigation in Okinawa.The insurance company paid a large sum of money because the subject of the investigation was unable to walk due to a leg injury and visited a hospital.Our investigators found that although the subject was seen going to the hospital, his condition was not serious enough to prevent him from walking, and that he reported his injuries as more serious than they were.
    We took video and photos of the subject walking and submitted them to the insurance company as evidence.
    When the insurance company pointed out the insurance fraud based on the evidence, the subject admitted to the insurance fraud.

    Conclusion


    Insurance fraud is a serious crime that can cost insurance companies dearly. An increase in insurance fraud has a variety of effects, including increased premiums for users as well as insurance companies.

    Investigations in Japan from the U.S. are physically difficult. Consultations are free of charge. If you need an investigation, please contact us.We will propose a plan that fits your company’s situation.