NC Dept of Insurance Insurance Scams!

Posted in: Madison Park
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PUBLIC SERVICE ANNOUNCEMENT

A Message from Insurance Commissioner Mike Causey

 

The Department of Insurance has seen a recent spike in cases of insurance fraud. I want to advise consumers to be on high alert and to know what we all can do to protect against the many clever tactics criminals and scammers use to get your personal and sensitive information.

 

Everyone ends up paying for insurance fraud. According to the Coalition Against Insurance Fraud, Americans are paying over $300 billion a year just to cover the known costs, or, about 20 cents of every insurance premium dollar that we pay.

 

One particular scam we’ve seen involves people going door to door posing as NC Department of Insurance employees and trying to sell fake insurance policies. Be aware that the Department of Insurance does not sell insurance and neither does any other state agency.

 

We have also seen a heavy increase in online scams targeting senior citizens, particularly those promising high returns on annuities and investments.

 

These scammers work to convince our seniors to take money out of their savings accounts and put them into annuities or savings accounts that promise high returns. But what they are selling are shoddy and scam products.

 

Many times when these seniors find out that they become a victim of a scam, they don’t want to report it. They don’t want their family to know because they’re too embarrassed to talk about it. What often happens in this situation is that they find out after that person passes away.

 

Another scam comes from medical doctors in other states writing prescriptions for North Carolina residents and sending them to accomplices working in pharmacists in North Carolina. Some people won’t bother to look at their explanation of benefits (EOB), but all charges should be itemized within that document.

 

The Department of Insurance received over 10,000 Medicare fraud complaints in 2023. Most of the complaints involved consumers being billed for supplies or durable medical equipment that they did not order or need. Other complaints involve beneficiaries being charged twice for a service they needed only once.

 

Our Seniors’ Health Insurance Information Program (SHIIP) and Seniors Medicare Patrol have worked with federal agencies to combat this problem.

 

Staged traffic accidents are another common scam we see across the state. Be careful driving and stay alert!

 

A recent case we handled saw one person take pictures off the internet of a wrecked vehicle and submit the same picture to more than 20 insurance companies, and only two of those companies found anything suspicious and reported it to us and got our investigators looking into it.

 

Fortunately, we have dedicated agents in our Criminal Investigations Division, who work to crack down on this type of behavior. But we still need your help to uncover it.

 

It’s important to not be a victim!

 

Here are 14 tips you can use to protect yourself from the many types of insurance fraud and scams:

 

  1. Too much of a good thing. Always remember that if it sounds too good to be true, it probably is.
  2. Record keeping. Do not pay insurance premiums in cash without the receipt that has the company or agency name on it and is signed by the agent receiving the payment. Keep all your records and proof of payments.
  3. Make a call. Call your insurance agent or insurance company before signing a contract or paying for repairs. Don’t let the contractor work directly with your insurance company unless your agent gives approval.
  4. Trust reputations and licenses. Work with only licensed and insured contractors.
  5. Be vigilant. Never give out their Medicare number or Social Security number to anyone except your doctor or people you know you should have it. 
  6. Protect yourself. Do not accept offers of money or gifts for free medical care, and don’t allow anyone except your doctor or other Medicare providers to review your medical records or recommend service.
  7. Watch out for phone scams. Never join a Medicare health or drug plan over the phone unless you have called them first.
  8. Get more than one estimate. Don’t be pushed into signing a roofing or repair contract right away.
  9. Get everything in writing. The cost and the type of work to be done, time schedule, guarantees, payment schedule and other expectations should be detailed.
  10. Require references and check them out.
  11. Ask to see the salesperson’s driver’s license. Write down the license number. Also take down his or her license plate number.
  12. Never sign a contract with blanks. Fraudulent contractors may enter unacceptable terms later.
  13. Wait until the job is finished. Never pay a contractor in full or sign a completion certificate until the work is completed.
  14. Let us know! Report insurance fraud to the Criminal Investigations Division of the North Carolina Department of Insurance

 

Our agents are on hand to take your report if you suspect insurance fraud. Our number is 888-680-7684.

 

For more information on how you can better protect yourself and stay informed, visit www.ncdoi.gov/consumers/disaster/protecting-yourself-scams and www.ncdoi.gov/fraud-control/recognizing-fraud.

Mike Causey

N.C. Insurance Commissioner

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