Journal of Insurance Fraud in America

Consumers have accidents every day, and insurers are there to protect them from the unexpected perils of everyday life. Laws have been enacted to protect our identities – including  everything from credit card fraud to hacking our computers. But did you ever think having an auto accident may trigger a behind-the-scenes scheme devised to determine your insurance policy’s limits in an attempt to potentially collect hundreds of thousands of dollars? In several states, disclosing your liability limits prior to litigation is prohibited for good reason: to combat such schemes to treat up to the amount of the policy limit. Read article.

by Gene A. Weisberg | June 2021

Telemedicine continues its rapid rise as a widely used emergency pandemic healthcare response. While initially a largely stop-gap measure to help home-bound patients receive medical treatment and diagnosis, much of telemedicine likely will remain a permanent and mainstream fixture in healthcare long after the U.S. emerges from its pandemic lockdown. Read article.

by Tami Rockholt, RN, BSN and Michael Fossey, MS, CPMA | April 2021

Sixty-six-year-old handyman Kevin Gavin was recently arrested for killing three elderly women in his apartment complex.(1)  While he has not yet gone to trial, investigators believe he had run errands for his victims.  His motive?  Money.  In fact, before his murder arrest, Gavin was apparently involved in all kinds of creative ways to earn a living; in 2019, he and two accomplices staged a Brooklyn collision so they could collect $150,000.  Read article.

by Dr. Joni Johnston | March 2021

The Illinois Supreme Court recently handed down an opinion involving the Illinois Insurance Claims Fraud Prevention Act that has significant implications for the future of that whistleblower statute and similar approaches to insurance fraud that other states may want to explore. Read article.

by Emily Stable, Phillips & Cohen LLP | February 2021

Synthetic persons, forged documents, bribery, murder, wire fraud and identity takeovers are just some of the fraud crimes besetting the life and health insurance industry. Read article.

by Kevin C. Glasgow, ARA, ACS, FLMI, FLHC, CLU®, CFE | December 2020

Many experts widely forecast a potentially significant surge of opportunistic fraud by financially stressed consumers looking for an insurance bailout during today’s pandemic. Read article.

by Taryn Hammond and James Rumph | November 2020

Medicaid fraud is the most lucrative business model in U.S. dentistry today. Inflated payouts can easily reach astronomical figures. Abusing vulnerable children and inflating billings for their treatment lie at the heart of this corrupt model. Medicaid fraud has allowed wrongdoers to amass huge personal fortunes from this state-federal taxpayer program for lower-income Americans. Read article.

by Michael W. Davis, DDS | November 2020

Artificial Intelligence — or AI — is a popular subject of discussion in anti-fraud circles. The vast availability of data and computing power to analyze it have fueled considerable excitement about AI for its breakthrough potential in combating insurance fraud. Read article.

by Dave Rioux | October 2020

Social inflation has been a hot topic in the insurance industry and among consumer advocates for several years. The concept generally refers to the alleged rising costs of insurance claims from increased number of civil lawsuits, larger jury verdicts, and the general favoring of plaintiffs in civil litigation. Read article.

by Jim Patillo & Jordan Loper | September 2020

The chiropractic profession has been a primary provider of treatment for musculoskeletal conditions over the past 125 years. I have witnessed amazing results, especially in personal injury and workers compensation. I have also seen inadequate delivery of treatment, phantom visits, and treating fake injuries through my time as an expert witness testifying in court cases. Read article.

by Dr. G. Steven Baer, DC, DABFP, DACBOH | August 2020

Property-casualty insurers seem mostly satisfied with their anti-fraud efforts, making few major changes in their SIU operations since the Coalition’s last study in 2017. Read article.

by DENNIS JAY | July 2020

Telemedicine once was limited to delivering healthcare services to patients who live in rural or isolated locations, and patients with limited mobility. With the COVID-19 pandemic the scope of medical services delivered via telemedicine technology has suddenly exploded. Read article

by THOMAS E. FRAYSSE, Esq. | June 2020

Shadowy organized criminal networks lurking in far-off lands pouncing on unsuspecting members of the public in safe, western societies loom large in the imagination of action film makers and thriller writers. Read article.

by DENNIS TOOMEY | May 2020

Those of us in the world of fighting insurance fraud have used the word “risk” throughout our careers. But do we ever really stop to think what that word means, and all it entails for our profession? The viral pandemic of COVID-19 has brought this word into the daily vocabulary of our nation, and the world. Read article.

by MATTHEW SMITH, Esq. | April 2020

During the previous economic downturn of 2008-10, consumers in the U.S. worried about the potential loss of jobs, their homes and life savings. This time around, face those stresses, and potential for loss of life as well. Read article.

by DENNIS JAY | March 2020

Recent reforms in Florida seek to reverse a rising tide of fraud and abuse stemming from storm repair claims that have sharply driven up homeowner premiums around the Sunshine State. Read article.


For the first time since our founding more than 27 years ago, the Coalition Against Insurance Fraud has a new Executive Director. I am humbled and honored to serve in this role. Read article.

by MATTHEW SMITH, Esq.| January 2020