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Insurance Fraud Casebook: Paying a Premium for Crime


Praise for Insurance Fraud Casebook

"From kickbacks to murder and physicians to cartels, these case studies read like a novel, yet provide practical and relevant considerations. This is a must-read for any professional working in the insurance arena."
--Tiffany R. Couch, CFE, CPA/CFF, Principal, Acuity Group PLLC

"Thirty-five years of police work and financial investigation taught me that there is just no substitute for experience, but if you haven't been there, learn from somebody who has. This compendium is an entertaining, enlightening, and practical aid for everyone who has an interest in fraud detection. I heartily recommend it."
--Roy Burnett, MS, CFE, Fraud Investigator, EE Ltd

"Can a book on insurance fraud be a great read? This one can: Armenian arsonists-for-profit, new tricks in identity theft and embezzlement, Russian mobster rip-offs and even manipulation of murder. A superb collection of the unusual, the tragic and the amusing, this is a casebook invaluable to the fraud investigation professional as well as students."
--Douglas M. Watson, PhD, CFE-RE, Point~CounterPoint Consultations, Izmir, Turkey

"Once again, the ACFE has produced a collection of excellent cases on the subject of fraud. In addition to very detailed case stories, an excellent 'Lessons Learned' section is included at the end of each chapter. This book brings fraud to life for students of fraud examination."
--Ron McNinch, PhD, CFE, SPHR, Public Administration and Legal Studies Chair, University of Guam

"This book is a great illustration of the depth and breadth of insurance fraud schemes and of the cost that we all pay for them. The examples and case studies are both informative and intellectually entertaining. A great read for everyone, from fraud examiners to basic insurance consumers."
--Ryan C. Hubbs, CFE, CIA, CCSA, PHR, Forensic Audit Manager, Internal Audit Services, Halliburton

LAURA HYMES, CFE, is the Managing Editor of the ACFE's Research Department, where she oversees the editing of books, manuals and other publications related to the prevention, detection and investigation of fraud. She also collaborates with authors and speakers who are experts in the anti-fraud industry to produce high-quality educational material. She has a master's degree in publication management and years of experience in editing and publishing.

Dr. JOSEPH T. WELLS, CFE, CPA, spent nearly a decade as a U.S. FBI Special Agent and is the founder and Chairman of the Association of Certified Fraud Examiners (ACFE) as well as the author of twenty-one books. For his landmark research in fraud detection and deterrence, Dr. Wells has been inducted into the American Institute of Certified Public Accountants' Business and Industry Hall of Fame and named to Accounting Today's list of the 100 most influential people for nine years in a row. He holds a doctorate in commercial science from York College, The City University of New York.

Preface ix

Insurance Fraud Classification System xiii

Chapter 1 Needles in a Paystack 1
Charles Piper

Chapter 2 The Good Doctor and Insurance Consultant 11
Michael King

Chapter 3 Greasing the Wheels in the Oil Business 21
Abdulrazaq Al-Morjan

Chapter 4 Living the Dream, Keeping Up the Lie 31
Andries J. Brummer

Chapter 5 Extinguishing an Arson Fraud 39
Barry Zalma

Chapter 6 Weakest Link in the Chain 47
Angela Bisasor

Chapter 7 Everyone Gets Hurt: A Study in Workers' Compensation Fraud 57
Michael Sputo

Chapter 8 The Hazards of Doing Business with Friends 67
Bill Maloney

Chapter 9 There's Gold in Them Thar Malls! 75
Carl Knudson

Chapter 10 Damsel in Diamonds 83
Michael Skrypek

Chapter 11 Operation Give and Go 93
Edward P. Buttimore

Chapter 12 An Inspection Is Worth a Thousand Photos 103
Ed Madge

Chapter 13 The Danger of Trusting Too Much 113
Joe Bonk

Chapter 14 The Twin Cities Machine 121
Bob Weir

Chapter 15 With Friends Like These . . . 131
John Fifarek

Chapter 16 All the Buzz 139
Dalene Bartholomew

Chapter 17 Getting Rich from the Elderly 149
John R. Holley

Chapter 18 Transparent Greed 159
Joseph Licandro

Chapter 19 Fault of Fortune 169
Jyoti Khetarpal

Chapter 20 Going Blind to Fraud 179
Karen Wright

Chapter 21 Going Against the Cartel 191
Loftin C. Woodiel

Chapter 22 Falling Prey to Online Charms 199
Tina Hancock

Chapter 23 Big Bills in Little Cuba 209
Mark Starinsky

Chapter 24 Rushing an Insurance Claim 217
Peter Parillo

Chapter 25 Ignorance Is Bliss, While It Lasts 229
Rebecca Busch

Chapter 26 The Name Game 239
William D. Meader

Chapter 27 Woo, Wed, Insure, Murder 249
William P. Hight

Chapter 28 Mystery Shopping for Fraud 259
Stephen Pedneault

Index 269