Insurance Insurance Fraud Detection & Prevention

Question 1

Which of the following best describes 'soft fraud' in insurance?

Accepted Answer

Exaggerating a legitimate claim to receive a higher payout than deserved

Answer

Fabricating an entirely false claim or accident that never occurred

Answer

Intentionally destroying property to collect insurance proceeds

Answer

Impersonating another person to obtain an insurance policy

Question 2

What is the primary purpose of the National Insurance Crime Bureau (NICB)?

Accepted Answer

To partner with insurers and law enforcement to combat insurance fraud and vehicle theft

Answer

To regulate insurance premiums and licensing requirements nationwide

Answer

To provide legal defense for insurers facing fraudulent claims

Answer

To issue standardized insurance policy forms across all states

Question 3

Insurance fraud is estimated to cost the US economy approximately how much annually?

Accepted Answer

More than $80 billion

Answer

Approximately $10 billion

Answer

Around $25 billion

Answer

Less than $5 billion

Question 4

Which of the following is a recognized red flag indicator of potential auto insurance fraud?

Accepted Answer

The accident occurs shortly after a new policy is issued or coverage is increased

Answer

The claimant files the report within 24 hours of the accident

Answer

The vehicle involved is less than two years old

Answer

The claimant has had no prior claims in the past five years

Question 5

What is a 'staged accident' in the context of auto insurance fraud?

Accepted Answer

A deliberately orchestrated collision intended to generate a fraudulent insurance claim

Answer

An accident recreated for safety training purposes at an insurance company

Answer

A simulation used by insurers to test their claims processing systems

Answer

An accident scene documented by law enforcement for court presentation

Question 6

Which federal agency has primary jurisdiction over insurance fraud investigations at the federal level?

Accepted Answer

The Federal Bureau of Investigation (FBI)

Answer

The Securities and Exchange Commission (SEC)

Answer

The Department of Homeland Security (DHS)

Answer

The Federal Trade Commission (FTC)

Question 7

Which behavior by a medical provider would most clearly constitute insurance fraud?

Accepted Answer

Billing for procedures or services that were never actually performed

Answer

Submitting claims within 30 days of service

Answer

Billing for multiple services performed during a single visit

Answer

Accepting both insurance payment and patient co-pays