(Analysis of 53 indicators of fraudulent foreign health insurance/medical expenses claims distilled from over 5,000 fraudulent claims investigated in Africa, Asia, South America, Central America, the Caribbean, and the Middle East for insurers, HMOs, and travel insurance companies in the United States, Canada, Europe, and Asia. They are enhanced with pictures and checklists of medical equipment for Claims Examiners and Investigators worldwide)
The indicators discussed in the book were taken from claims under such policies as follows:
· Travel Insurance (Medical Expenses)
· Individual Health Insurance
· Personal Medical Insurance
· Critical Illness / Care
· Living Needs Benefit Insurance
· Group Health Insurance
· Hospital Confinement / Indemnity
· Workers’ Compensation Insurance
· Disability Insurance
· Personal Accident Insurance
· Personal Accident Liability
· Dental Insurance
-You will purchase the book for your library. However, we assure you that it would not be placed on the shelf but on your working table-
If you have ever handled foreign insurance claims or outsourced claims for on-site investigation as a Claims Examiner or an Investigator under any of the above policies, this publication is for you as well as the field investigator. It is relevant for Life and Health Insurance Claims Examiners, Travel Insurance Claims Professionals, Insurance Attorneys, Solicitors, Loss or Independent Adjusters, Investigators in Insurance Fraud Bureaus, and law enforcement officers and prosecutors worldwide.
Never again be hoodwinked by unscrupulous providers or the physicians who think they can sit in a corner of their consulting office whether in Africa, Asia, South America, Central America, the Caribbean and the Middle East and fabricate treatment and medical records without the fraud being detected.
· Eight (8) observations in a hospital’s manual patients’ or admission register that would indicate you are dealing with a fraudulent foreign health insurance claim
· The differences in a private room, semi-private room and patients’ ward in words and pictures
· The differences in ECG and EEG in words and pictures
· The differences in MRI and CT scan in words and pictures
· What constitutes an Intensive Care Unit (ICU) in words and pictures
· The differences between an ambulance and a hearse
· The checklists of medical equipment for each section of a hospital that could immediately be utilized by the field Investigator
· The psychology exhibited when the policyholder and/or the physician alleges that treatment was for three illnesses such as for malaria, typhoid and gastroenteritis in one confinement
· The psychology displayed if the physician refuses to provide treatment and medical records even when presented with an Authorization signed by the policyholder
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