An insurance fraud investigation must be focused on determining exactly how the fraud was perpetrated, as understanding the method of the insurance fraud will also likely prove that insurance fraud did take place. A fraud investigator, then, will often focus his attention on examining the potentially fraudulent ways that the claimant might have manipulated events such that he could make his insurance claim.
Depending on exactly what type of insurance the claim is being made on, there could be any number of different methods for perpetrating insurance fraud. It's up to the fraud investigator to narrow down those methods, to find the one that was employed, or else to find that no method fits the incident, and there is no fraud.
Life insurance is one of the most obvious in terms of methods for insurance fraud, and the fraud investigation will likely be focused on the sole available route. The only way that insurance fraud can be perpetrated with life insurance is if the individual protected under the life insurance did not actually die, but instead faked his death, so that someone close to him could collect on the claim, and then likely share the money.
The fraud investigator, then, will be focused on trying to prove either that the individual is genuinely dead, or that he has faked his death and perpetrated insurance fraud. Such a fraud investigation is often difficult in the search, but it has quite a clear goal: if the individual in question is every discovered to be alive, then insurance fraud was perpetrated almost without a doubt.
Health care insurance fraud is far less clear cut than life insurance fraud, and fraud investigation into it will likely need to be much more nuanced, and much more penetrating. Health care insurance fraud is most often perpetrated by health care providers because those doctors will lie in order to get the best possible service for their patients.
Doctors can lie on billing, telling insurance companies that they performed one service, while in actuality they performed an entirely different operation, most likely because the insurance company will cover the service actually listed, but not the service actually performed. It is up to fraud investigators to determine whether or not the actually performed operation was the one listed on the bill. Other types of insurance fraud for health care insurance often involve significantly more mercenary aims, as doctors can perpetrate fraud in an attempt to get more money.
Performing unnecessary medical procedures and billing for them is one key way that this kind of fraud takes shape; prescribing medical help without any actual need for it is a common way for doctors to earn more money, either for themselves or associates. The only way for a fraud investigation to successfully out such practices is for the fraud investigator to consult with other medical professionals, in the hopes of discovering whether or not any given procedure was actually necessary.
Car insurance fraud takes form in a similar fashion to the more mercenary forms of health care insurance fraud. Claimants will sometimes attempt to make money by claiming that injuries not related to a car accident were actually caused by the car accident in question, so as to make some money for the injuries; or they will claim that the repairs on the car that should fall under the protection of insurance cost more than they actually did.
These forms of car insurance fraud are more common, and easier for fraud investigations to out, considering that records are likely to exist that will either prove or disprove the claim. Car insurance fraud can also involved staged accidents, however, or faking injuries from a car accident. These may be a bit harder to detect for a fraud investigator, not least because these types of fraud often involve a greater degree of care and precision in the perpetration. But nonetheless, a good fraud investigator will be able to find the truth through the deception, and will be able to prove that the claims are fraudulent.
