State refers record insurance fraud cases for prosecution [The New Hampshire Union Leader, Manchester] – InsuranceNewsNet


July 14 – CONCORD – State investigators have referred a record 22 cases of suspected insurance fraud for prosecution by state and federal authorities in the past year, state officials say.

Insurance Commissioner Christopher Nicolopoulos said these cases, representing nearly $283,000 in fraudulent claims, are expected to file individual indictments in the coming months.

“Our prosecution record shows that New Hampshire has zero tolerance for insurance fraud,” Nicopoulos said.

Brendhan Harrisfraud investigator in charge of Insurance Departmentsaid the state prosecutes any fraud on $1,000 as a crime.

“With the rising costs of auto repairs, for example, the threshold for an insurance fraud charge is very low,” he said.

This latest report includes two workers’ compensation claims, one home insurance claim, one disability insurance claim and 18 cases of alleged auto insurance fraud.

Each month, the fraud unit receives an average of 25 referrals, opening files on approximately 12% of them.

During the State fiscal year that ended on the last June 30ththe office received 298 reports of fraud, opened 37 cases and referred 22 for prosecution.

Harris, a retiree Virginia Beach, Virginia.policeman, came to the Insurance Department 15 years ago to lead the four-person unit.

“One hundred percent of the cases we submitted were prosecuted. We don’t want the reputation of a unit that pursues and accuses fraud and then ends up with cases that didn’t materialize,” Harris said.

New Hampshire does not have a mandatory car insurance requirement.

Harris said the most common form of insurance fraud here involves motorists obtaining insurance coverage after being in an accident and then claiming they were covered.

“We resolve almost 100% of these cases,” Harris said.

Unlike some law enforcement agencies, the New Hampshire Department of Insurance has its own subpoena power, so it can immediately request and quickly obtain bank or cellphone records that confirm or disprove someone’s claim that they had insurance, Harris said.

In 2020, Harris’ office broke the complicated case of Leo Rusha 76 year old man Pelham man who pleaded guilty in federal court to setting up four fake insurance companies that sold fake bonds.

In seven years, Rush has obtained $633,000 in payments selling fake bonds valued at more than $23 million.

Harris remembers having a document in his hands confirming that Rush had posted a false bond to a Connecticut customer at a Federal Express store on the New Hampshire border.

“It doesn’t get any better than this when you have this piece of paper that nails the case you’ve been working on for months,” Harris said.

Sophisticated counterfeits

In 2020, Jacqueline Masse of Hampton was sentenced to 18 months in federal prison for attempting to defraud restaurants and their insurance companies $400,000claiming that she or a member of her family became seriously ill after eating their food.

Masse was the business manager of her husband’s law firm and falsified her client’s legitimate medical records to file the claims.

Harris said the break in that case came when he called Elliot Hospital and confirmed that Masse had claimed as her own a medical record number belonging to her husband’s client.

Since COVID-19, Harris said the level of sophistication of these fraud claims has increased.

“People are working from home. They have more free time and access to software to create these amazing documents,” Harris said.

“I have never seen so many fake discs that look legitimate fall on my desk in the past year.”

What’s also changed since the pandemic is that many insurance companies don’t send their agents to review claims in person, but rely on paperwork sent to their offices, Harris said.

At the national level, insurance fraud (excluding health insurance) is a $40 billion-a year-long criminal enterprise that costs on average WE family between $400 and $700 per year in increase in insurance premiums, according to the FBI.

About 75% of insurance industry professionals believe that 10% or more of all claims have an element of fraud, according to the 2020 Friss Insurance Fraud Report, a company that provides fraud and risk detection software to insurance companies. insurance.

Some industry professionals estimate that the number of claims with an element of fraud has nearly doubled since the COVID-19 pandemic.

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