“You want money for yourself—it’s greed. You don’t see it as wrong. You see it as white collar. There’s not a lot of risk. You don’t live in fear
because you don’t think you’ll ever get caught,” - Castillo told a reporter.
state’s largest no-fault auto-insurance
bust in recent years.
Five clinics allegedly were involved. At
least 26 suspected gang members were arrested. They included a clinic owner, doctors, clinic employees and staged-crash
recruiters and others. Three generations
of one family allegedly took part—a
mother, daughter and granddaughter.
The rise of corporate-caliber gangs
with international ties and multi-industry
scams raises the ante by several degrees of
magnitude for fraud fighters, especially in
auto, health, and workers’ compensation.
The investigative model of the future thus
will involve ever-higher levels of collaboration in varied permutations.
Task forces and other units focused
solely on organized crime and specific
ethnic groups already are a large part of
the anti-fraud landscape at the federal,
state and even city levels. The coordination can be intricate.
However, the government and private
sectors also will come together in other
ways and work across lines of insurance.
Organized crime gangs are multitask-
ing across lines of insurance. The same
gang may be fleecing Medicare and run-
ning medical mills connected to staged-
crash rings. But we don’t know how big
the problem is because fraud fighters in
different lines don’t often compare notes.
Presenting A United Front
Closer coordination of investigations
among the lines of insurance—and between the public and private sectors—is
the necessary model of the future. This
highly integrated approach will unearth
far more well-hidden crimes, case leads
and evidence than can each sector working largely alone.
Private insurers have large bodies of
insight and leads about auto and health
scams as well as known crooks. The feds
also have large pools of information
about Medicare and Medicaid cons. So
it makes perfect sense to work in tandem. Anti-fraud vocabulary also could
The feds and private sector
are collaborating more
regularly on insurance
cases. It’s still relatively
informal, and a work in
progress, but important
progress is being made.
change. The term “medical fraud” may
become the commonly used umbrella
term for bogus treatment involving
crash rings, health insurers and workers’
comp medical mills.
The feds and private sector are collaborating more regularly on insurance
cases. It’s still relatively informal, and a
work in progress, but important progress is being made.
With so many organized-crime gangs
working multiple crimes such as insurance, banking, and credit-card fraud, the
concentric circles of anti-fraud collaboration and information sharing thus should
keep extending farther outward to other
industries and related government agencies—domestic and international.
If more of the vast criminal underworld perceives insurance fraud as a soft
and lucrative target, then the insurance
industry could well continue seeing a
growing penetration by organized criminals. This will only increase the already
debilitating outflow of insurance money
and place yet more upward pressure on
premiums. Moreover, that stolen money
may help finance other domestic and international crime that erodes American
society and its values.
The insurance industry is entering uncharted waters of cooperation and collaboration. The challenge is to be more
organized than organized crime. K
Dennis Jay is the executive director of
the Coalition against Insurance Fraud
(CaIF). For more information, visit the
CaIF website, www.insurancefraud.org.