Fraud News / Claims Pages

How AI is Transforming Insurance: Opportunities and Challenges

Artificial intelligence is revolutionizing the insurance industry, enhancing efficiency and accuracy, but its adoption requires overcoming technical, ethical, and regulatory challenges.

January 8 Fraud Insurance Industry Underwriting

Florida Couple Accused of Running $11 Million Insurance Fraud Scheme via Unauthorized Dental Practices

A Florida couple allegedly orchestrated an $11 million insurance fraud scheme through unauthorized dental practices, deceiving patients and insurers to fund a luxury lifestyle.

January 7 Fraud Insurance Industry Legislation & Regulation Risk Management Florida

AI in Claims: The Battle Against Fraud’s High-Tech Evolution

Insurance companies are leveraging AI to combat claims fraud while grappling with criminals using the same tools to exploit vulnerabilities, driving an urgent need for innovation.

December 30, 2024 Fraud Litigation Risk Management Technology

Minnesota Secures $300K Settlement with Florida Firm Over Worker Misclassification

A Florida company, accused of misclassifying Minnesota workers, settles for $300,000 and halts operations in the state, addressing worker misclassification and lost benefits.

December 26, 2024 Fraud Insurance Industry Legislation & Regulation Workers' Compensation Florida Minnesota

Florida Man Accused of Hurricane Irma Insurance Fraud

A man from Coral Springs, Florida, is under investigation for insurance fraud after allegedly filing a false claim for Hurricane Irma damages, with encouragement from their public adjuster.

December 26, 2024 Fraud Insurance Industry Litigation Property Florida

Insurance Company Targets 180 Health Care Providers in $450M Fraud Lawsuit

American Transit Insurance Co. has filed a $450 million lawsuit against over 180 healthcare providers under the RICO Act, alleging no-fault insurance fraud, kickbacks, and overbilling in New York.

December 26, 2024 Fraud Insurance Industry Legislation & Regulation Litigation New York

US Watchdog Targets Major Banks Over Alleged Fraud on Zelle Payment App

The Consumer Financial Protection Bureau has sued JPMorgan Chase, Bank of America, and Wells Fargo, alleging insufficient protections against fraud on the Zelle payment platform, impacting consumers nationwide.

December 20, 2024 Fraud Legislation & Regulation Litigation Technology

How Artificial Intelligence is Transforming Workers’ Compensation

Artificial intelligence is reshaping workers’ compensation by improving fraud detection, streamlining claims processes, and enhancing injury prevention—but ethical implementation is key.

December 19, 2024 Fraud Risk Management Technology Workers' Compensation

CVS Faces Federal Lawsuit Over Alleged Opioid Dispensing Missteps

The DOJ alleges CVS pharmacies knowingly dispensed opioids unsafely, ignoring red flags and understaffing stores, as part of a whistleblower suit under the False Claims Act.

December 19, 2024 Fraud Legislation & Regulation Litigation Risk Management Rhode Island Tennessee Texas

Iowa Roofing Company Barred from Acting as Unlicensed Public Adjuster

Darren Reeves Roofing is ordered to cease unlicensed public adjuster services, including negotiating insurance claims or offering advice on insurance contracts, following a consent order in Iowa.

December 16, 2024 Fraud Insurance Industry Legislation & Regulation Litigation Iowa

Global Insurance Fraud Detection Market to Hit $31.8 Billion by 2032

Fueled by AI, ML, and big data analytics, the global insurance fraud detection market is projected to grow at a CAGR of 25%, with strong demand from Europe, North America, and APAC.

December 12, 2024 Fraud Insurance Industry Risk Management Technology

California Insurance Agent Faces Fraud Charges Over $900K Long-Term Care Scheme

A former insurance agent in Cupertino has been charged with fraud after allegedly claiming over $900,000 in long-term care benefits for herself and her father under false pretenses.

December 12, 2024 Fraud Legislation & Regulation Life & Health Litigation California

Teen Arrested in Scattered Spider Cybercrime Case Linked to Telecom and Crypto Hacks

Authorities have arrested a teenager linked to the Scattered Spider gang, accusing them of hacking financial and telecom firms and launching phishing campaigns targeting employees and customers.

December 9, 2024 Fraud Litigation Risk Management Technology Florida North Carolina Texas

AI Brings Speed, Precision, and Control to Insurance Operations

Artificial intelligence is transforming the insurance industry by automating processes, enhancing fraud detection, personalizing policies, and streamlining customer service.

December 4, 2024 Fraud Risk Management Technology Underwriting

Missouri Farmer Featured on Reality TV Show Pleads Guilty to Multi-Million-Dollar Crop Insurance Fraud

A Missouri farmer, known for his role in a reality TV series, has pleaded guilty to a multi-million-dollar crop insurance fraud scheme involving falsified federal benefit claims.

December 3, 2024 Fraud Insurance Industry Litigation Missouri