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By Diane Kellner
Arab World
The incidence of fraudulent death claims in the Middle East is increasing. Countries in this area of the world are heavily populated with various sects of Muslims, although there are also some Christians. Investigative results may vary depending upon whether the investigator is Christian or Muslim. Also, be aware that cemeteries are segregated by religion and sect. A Christian would not be buried in a Muslim cemetery; a Shiite Muslim would never be buried in a Sunni Muslim cemetery, etc. Claims of such burials can provide a valuable clue.
Columbia
Columbia has a high incidence of kidnappings among the wealthy. Many times the abducted parties are killed whether or not ransom demands are made. A disproportionately higher number of violent deaths with unusual circumstances also come out of Columbia. Murders involving spouses, bodyguards, boyfriends, etc., which are explained away as accidental shootings, are relatively common.
Germany, Austria and Hungary
These countries all offer socialized medical coverage on their citizens, including spa treatments for such ailments as rheumatoid arthritis or chronic back pain, etc. Many of the treatments accepted as medically necessary in Europe would be rendered as outpatient care — that is if they were rendered at all — in the States. Further. most US insurers would consider these providers to be health spas, and the treatments they offer would be classified as elective. Nevertheless, many patients receiving such care abroad — free of charge — will frequently file for benefits with their US carriers, even when they know that the treatments rendered are not available in the US and would not be deemed medically necessary here.
Ghana
A large number of claims from this region involve snake bites. Sometimes, the real snakes are those filling out the claim forms.
Greece
Hospitals in Greece tend to have very low occupancy rates. Sometimes, patient rooms are rented out to vacationers, just like hotel rooms. Be sure to obtain treatment records before paying any hospitalization claims supported only by hospital bills. All medical records or invoices from Greece must contain tax stamps to be valid.
Haiti
Haiti is one of the easiest places in the world to obtain bogus claim documents. There is significant graft and corruption in the government and among local authorities. Further, no one seems to care about fraud. Consequently, absolutely anyone, dead or alive, real or fictitious, can obtain false birth certificates, death certificates, passports, etc., from any one of hundreds of suppliers. The illegal suppliers frequently peddle their wares right outside local civil registrars’ offices throughout the business day. For the most part, the bogus claims out of Haiti seem to be death claims rather than medical or disability claims.
The Haitian currency is very confusing. The Haitian dollar is worth considerably less than the US dollar and a local who says, “give me a dollar, ” actually means that he wants five gourdes, the equivalent of 35 cents. If he asks for a US dollar (when a Haitian says dollar, he is referring to the Haitian dollar unless he especially indicates otherwise), lies requesting 15 gourdes. A $900 Haitian medical bill could be settled with $300 US, but the doctor or hospital will not volunteer this information.
Mexico
Watch medical bills for unbundling, excessive rates (based upon US rates rather than local customary rates), and bills which mask charges for non-approved treatments. Diagnoses of cancer, ALS, Alzheimer’s, and other incurable degenerative diseases should signal possible alternative medical treatments, regardless of what itemized bills might say.
Nigeria
This African country has even higher levels of government corruption than Haiti and it is arguably the world’s most active producer of fraudulent claims. Death Kits, containing numerous falsified documents, are readily available in Nigeria.
In addition to the numerous fabricated hospitalization claims, grossly inflated bills and exaggerated treatments, Nigeria is also a world leader in narcotics trafficking and a home to various banking schemes involving advanced fee frauds. Those who refuse to cooperate with the fraudsters are often threatened with grave consequences.
Pakistan
There is currently a large amount of fighting (street snipers, etc.) in Karachi, making full investigations difficult. There are many false hospital claims coming out of Pakistan. In some cases, the “hospital” address turns out to be a drug store that belongs to a relative of the claimant. Some USA Pakistani Nationals attempt to pay for visits to their homeland via bogus hospitalizations claims.
Another thing to watch carefully — not only in Pakistan, but in any foreign country that uses a different currency — is the monetary unit used in billing. A few clever claimants have been caught adding a dollar sign before a billing number calculated in rupees. And since a traveler can currently exchange an American dollar for 31 rupees, the difference becomes quite significant.
Philippines and Thailand
These countries both have significant levels of corruption which allow falsified hospital invoices, police reports and death certificates to be obtained somewhat easily. There have even been documented instances from both countries in which local police officers and civil registrars have aided claimants in filing false claims using unidentified corpses.
Switzerland
Swiss hospitals and physicians will rarely honor authorizations for release of medical records. It is a rare doctor who will even allow an inspection of treatment records. Rather, most prefer to be interviewed and may provide a brief written summary Of the care given. This is simply a cultural difference and should not be construed as an indication of fraud.
Taiwan, China, and Vietnam
These three countries all require residents to register with the local authorities so that the government knows at all times where every individual resides. This makes locates and verification of documents fairly simple. Government level collusion in insurance fraud is rare if it exists at all.
Tidbits
Whenever you are dealing with a language which does not use our alphabet (such as Cantonese, Farsi, Korean or Thai), it is wise to get the correct spelling of the insured’s name in his or her native language prior to investigating the matter. This will help you avoid any possible misspellings during handling of oversea claims.
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Diane Kellner has been an investigator with First Services based in Jericho NY since 1985. She specializes in life and health claim investigations and has handled claim matters in 28 countries around the world. She is the editor of First Service’s International Assignment Advice Newsletter.
@1995 John Cooke Fraud Report