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Fraud

MEDICAL,USA: 1. An intentional misrepresentation of the facts to deceive or mislead another. 2. In a health care setting, the intentional deception or misrepresentation that an individual knows, or should know, to be false, or does not believe to be true, and makes, knowing the deception could result in some unauthorized benefit to himself or some other person(s). In addition, fraud may be committed by either providers or patients to obtain services, payment for services, or claim program eligibility. 3. In insurance claims, some fraudulent practices are intentionally double billing for the same services, reporting diagnoses and procedures to maximize payments, billing for services that were not performed, altering claim forms for higher reimbursement, soliciting or receiving kickbacks or bribes, using another person’s Medicare card, and falsely representing services provided. 4. Lying or intentional misrepresentation by insurance company managers, employees, agents, or brokers for their own gain.
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Obtaining an advantage by unfair or wrongful mans. Deception or artifice used to deceive or cheat.
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The intentional perversion of the truth in order to mislead someone into parting with something of value. Black’s Law Dictionary, 6th Edition, defines “fraud” as an intentional perversion of the truth for the purpose of inducing another in reliance upon it to part with some valuable thing belonging to him or to surrender a legal right a false representation of a matter of fact, whether by words or by conduct, by false or misleading allegations or by concealment of that which should have been disclosed, which deceives and is intended to deceive another so that he shall act upon it to his legal injury.

Frauds in Insurance

Fraud is defined as an intentional misrepresentation of material existing facts made by one person to another with knowledge of its falsity and for the purpose of inducing the other person to act, and upon which the other person relies with resulting injury or damage. Insurance fraud occurs when any act is committed with the intent to fraudulently obtain some benefit or advantage to which they are not otherwise entitled or someone knowingly denies some benefit that is due and to which someone is entitled. Types of insurance fraud are very diverse and occur in all areas of insurance. Insurance crimes also range in severity, from slightly exaggerating claims to deliberately causing accidents or damage.Some fraud indicators are claims made shortly after the policy inception, serious underwriting lapses observed while processing a claim, insured overtly aggressive in pursuit of a quick settlement, willing to accept small settlement, documents of doubtful nature, insured behind in loan repayment, accident un-witnessed and not promptly reported, invisible injury, high value leakage claim without any known casualty.

Fraudulent claims

Claim where the insured has: (a) made false statements of fact; or (b) made statements, knowing them to be false, or not believing them to be true, or without caring whether they were true or false. Good faith, implied in all insurance contracts, requires that any claim by the insured shall be honestly made. If the insured submits a fraudulent claim all benefit, including the premium, under the policy is forfeited. See CHEATLINE.
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Dishonest claims made by people who suffered no loss or who magnify a loss for their own gain.

Fraudulent Delivery

In connection with Transportation floaters, when a shipper surrenders goods to someone posing as an agent for the carrier, it is held that the goods did not come into the custody of the carrier. If the carrier delivers goods to someone posting as an agent for the receiver, it is held that no valid delivery is made, and the courier is held liable for the loss.

Fraudulent misrepresentation

UK: Breach of the duty of utmost good faith occurring where the person knowingly makes a false statement relating to a material fact, does not believe it to be true or makes it recklessly without due regard to its accuracy. The Road Traffic Act 1988 makes it a statutory offence for a person to make a false statement or to withhold material information for the purpose of obtaining a certificate of motor insurance required by the Act.
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MEDICAL,USA: False statement to get an insurance company to provide insurance coverage for an applicant. Fraudulent misrepresentation gives an insurance company grounds to terminate a policy at any time.
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Misrepresentation made knowingly with intent to deceive, or recklessly without care whether it be true or false.

Fraudulent trading

Occurs when a company continues to trade and incur debts, when, to the knowledge of the director(s), there is no reasonable prospect of the creditors being paid. It includes a situation where there are no good grounds for believing that the company can pay its way even if the director(s) hold an opposite view. Any director guilty of fraudulent trading may be liable to contribute to the company’s assets. See DIRECTORS’ AND OFFICERS’ LIABILITY.