An Austin-based small group health insurer settles allegations of fraudulent billing practices, emphasizing the need for transparency and ethical standards in health insurance claims.

A California school board trustee has been indicted for allegedly misusing public funds and filing a false insurance claim. A jury trial is set for March.

Cargo theft incidents surged 27% in 2024, reaching 3,625 reported cases in the U.S. and Canada. California and Texas were hit hardest, with criminals shifting to high-value targets like electronics and copper.

Agentic AI is reshaping claims management by automating repetitive tasks, supporting desk adjusters, and addressing challenges like workforce gaps, scalability, and customer satisfaction.

California authorities, including Insurance Commissioner Ricardo Lara, are addressing rising fraud cases after wildfires, deploying resources to protect survivors and prosecute scammers.

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

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

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.

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

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.

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.

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.

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

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.

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.