Publications

   Insurance consumer organization
   highlights insurance consumer protection
   with Coalition presentation on generative
   AI and fraud.



The Insurance Consumer Affairs Exchange (ICAE), celebrated its 49th year as the premier forum for regulators, insurers, and consumer groups, hosted its Annual Exchange in Boise, Idaho, where the Coalition Against Insurance Fraud was invited to present on the fast-growing antifraud benefit and threat of generative AI. Idaho Director Dean Cameron opened the program by reminding attendees that state-based regulation remains “closest to the consumer.” A commissioners panel with leaders from Idaho, Oklahoma, and Mississippi explored challenges such as towing abuses, post-disaster contractor fraud, and the use of AI in consumer complaint handling. Coalition Director of Government Relations Brent Walker delivered a featured presentation, Generative AI, Fraud and the Insurance Consumer, which highlighted findings from past Coalition research studies and its recent 2025 Generative AI study. The presentation underscored that while AI can assist in fraud detection and case documentation, it is also enabling increasingly sophisticated consumer scams, fake claims, and fabricated evidence. Input from the audience revealed that state consumer affairs staff are beginning to see generative AI being used by insurance consumers to write complaints, often with inaccurate or unrelated references, causing an increase in the time it takes state regulators to clarify these consumer complaints.

The Coalition urged two governors to pass antifraud workers compensation bills this week. The first issue was focused on closing a loophole in California where case law has seemingly limited workers compensation kickback schemes to misdemeanor penalties, rather than felony punishment. As pointed out in the letter to Governor Newsom, comments made during hearings on this bill called it, "common sense legislation that provides prosecutors the tools to properly choose how to handle those cases involving those who prey on injured workers and ensures greater accountability for the criminal acts." Also this week, the Coalition urged New York Governor Hochul to pass a bill that would establish a workers’ compensation fraud assessment commission, funded by employers in the state for he investigation and prosecution of workers’ compensation fraud. Along with the Coalition's support, it was also pointed out that to be successful and true to the bill's purpose, the future assessment must be dedicated to the sole purpose of investigating and prosecuting workers compensation fraud with effective oversight and accountability. Coalition members can search and track antifraud legislation on the Coalition's online interactive map.

North Carolina insurance commissioner warns that insurance fraud hits everyone in the wallet. North Carolina Insurance Commissioner Mike Causey recently wrote that insurance fraud is not a victimless crime and it drives up costs for all consumers. Commissioner Causey cited the Coalition Against Insurance Fraud study estimating that fraud costs Americans some $308.6 billion annually, or roughly $933 per person, or nearly $3,800 per family of four. He emphasizes that insurers must absorb fraud losses, and those costs get passed along to consumers in premiums. Causey urged North Carolinians to remain alert for red flags, report suspected fraud to the North Carolina Department of Insurance, and be wary that consumers themselves can commit fraud by exaggerating claims or falsifying information.

Regulators and trade leaders gather in Boston to discuss insurance issues, including fraud. Insurance regulators and state trade leaders put fraud and consumer trust at the forefront during this week’s State Insurance Trade Association (SITA) conference in Boston. Massachusetts Commissioner Michael Caljouw, joined by Connecticut’s Andrew Mais and Rhode Island’s Elizabeth Dwyer, cautioned that staged accidents, contractor fraud, and rising litigation costs are straining affordability and availability. Regulators underscored that while artificial intelligence and consumer data tools are reshaping underwriting and claims, state bulletins and model laws must remain flexible enough to keep pace with evolving technologies. Fraud emerged as a recurring theme in multiple sessions. Brent Walker, Director of Government Relations for the Coalition Against Insurance Fraud, participated on a contractor fraud panel, highlighting the national cost of fraud, consumer attitudes toward fraud, and solutions ranging from awareness campaigns to stronger laws. The conference reinforced a central message for Coalition members and stakeholders alike: state-based regulation, collaboration, and vigilance are essential to protect consumers and maintain a fair insurance marketplace.

    Expert urges AI and empathy in insurance     claims response.

Maurice Zicman, vice president of CX strategy at TP in Australia, has addressed the shifting landscape for insurers as extreme weather events become increasingly common and severe. Zicman noted that weather is now a central factor in driving insurance claims, with the industry facing mounting operational challenges. Recent data from the Insurance Council of Australia (ICA) indicates that, in the first half of 2025, insurers processed more than $1.8 billion in claims linked to extreme weather, stemming from over 148,000 separate incidents. Notable events such as Ex-Tropical Cyclone Alfred, which accounted for more than $1.36 billion in losses, and widespread flooding in North Queensland and the NSW Mid North Coast and Hunter regions, have demonstrated that large-scale weather events are a recurring issue rather than isolated anomalies. Zicman identifies the main challenge as the need to expand capacity while maintaining fairness and transparency in claims handling. “The opportunity lies in combining digital capabilities with the empathy that only human claims professionals can provide, ensuring technology augments, not replaces the human empathy during times of crisis.,” he said. Traditional claims processes can be strained by these surges, highlighting the need for solutions that combine technology and human expertise.

UK insurance sector turns to AI to tackle huge spike in insurance fraud. The UK insurance sector has intensified its crackdown on fraud, with new figures showing the scale of the problem facing both the market as a whole and individual firms. The Association of British Insurers (ABI) reported that in 2023 insurers detected £1.1 billion in fraudulent claims, an increase of 4% compared with 2022. The ABI said insurers identified 84,400 fraudulent claims in 2023, more than 11,000 higher than in 2022. The average case was worth £13,000. Motor fraud remained the dominant category, with 45,800 cases valued at £501 million, more than half of the total. Property fraud also climbed, with claims worth £143 million, while insurers blocked 583,000 false applications, a 17% increase. The ABI and the Insurance Fraud Bureau (IFB) have highlighted the impact scams can have on victims, with IFB Director Ursula Jallow warning that fraud carries financial, social and psychological consequences. Detective Chief Inspector Tom Hill of the City of London Police’s Insurance Fraud Enforcement Department said fraud is “not a victimless crime,” pointing out that scams can increase premiums and put motorists at risk.

Allianz UK uncovers £93M in insurance fraud during H1 2025. Allianz UK has detected more than £92.6 million in fraudulent insurance activity during the first half of 2025, marking a 34% increase compared with £68.9 million in the same period last year. The insurer said it identified more than 15,800 instances of fraud across personal, commercial and specialty lines. For insurance brokers, these figures underscore the need for robust fraud detection strategies and proactive client education. As fraud schemes grow more sophisticated, brokers play a critical frontline role in helping clients navigate evolving risks and ensuring claims integrity across all segments of the market. The rise reflects persistent challenges across the market. Allianz highlighted continued pressure from ghost broking schemes, where criminal gangs sell fraudulent policies, often targeting vulnerable customers such as gig economy and delivery drivers. The schemes have grown more sophisticated, with multiple policy amendments and short-term policy manipulation used to avoid detection. Other emerging patterns included exaggerated and fabricated non-tariff personal injury claims, where fraudsters seek higher payouts than those available under fixed-tariff whiplash rules. Allianz also reported a surge in "ballooning" claims, which start as modest losses before rapidly expanding once liability is admitted.

California couple accused of stealing patient identities in alleged insurance fraud scheme.

When patients across Orange County began noticing mysterious charges for medical tests they had never received, the trail of unexplained bills led investigators to an unlikely source: a Mission Viejo medical office and a quiet neighborhood in Irvine. Authorities say the discovery unraveled an insurance fraud scheme in which an Irvine couple, Rebecca Juarez and Juan Pablo Rodriguez allegedly stole the identities of more than 21 patients and used the information to submit fake insurance claims worth more than $10,000. The allegations: The case began after several residents filed complaints with the Orange County Sheriff’s Department, reporting that their health insurers had billed them for tests and treatments that never took place. Investigators with the California Department of Insurance soon joined the inquiry, tracing the phantom charges back to patient records at a Mission Viejo medical practice where Juarez worked. Juarez secretly accessed the office’s computerized medical records system and copied patients’ personal information. She is accused of passing those details to Rodriguez, who allegedly used his access to the billing system of a medical practice in San Jose to create fictitious medical records. 

Physician sentenced to 14 Years for illegal distribution of opioids and health care fraud conspiracies. Neil K. Anand from Pennsylvania was sentenced to 168 months in prison for orchestrating conspiracies to commit health care fraud, wire fraud, and unlawful distribution of controlled substances and money-laundering related offenses. He was also ordered to pay over $2 million in restitution and over $2 million in forfeiture. Anand conspired to submit false and fraudulent claims to health plans provided by Medicare, the U.S. Office of Personnel Management (OPM), Independence Blue Cross (IBC), and Anthem, for “Goody Bags” of medically unnecessary prescription medications, which were dispensed to patients by in-house pharmacies owned by Anand. In total, Medicare, OPM, IBC, and Anthem paid over $2.4 million in reimbursements. To entice patients to take the unwanted Goody Bags, Anand also conspired to distribute oxycodone outside the usual course of medical practice and without a legitimate medical purpose. In furtherance of the conspiracy, unlicensed medical interns wrote prescriptions for controlled substances using blank prescriptions that were pre-signed by Anand. As part of the scheme, Anand prescribed 20,850 oxycodone tablets for nine different patients. After learning that he was under investigation, Anand concealed the proceeds of the fraud by transferring approximately $1.2 million into an account in the name of a relative and for the benefit of a minor relative. 

Iowa man arrested on warrant for auto insurance fraud charge. Steven Browning of Sibley is accused of presenting false information to an insurer. He was arrested last Sunday. Prosecutors say: In his statement, the agent says the case involves an automobile accident that happened in July of 2024. He says a review of Browning’s Progressive Policy found that a 1995 Dodge Ram and Chrysler Town and Country had been added to the insurance policy on the day of the accident with a $100 deductible for collision and a $1,500 deductible for comprehensive. He says Browning then reported the accident to Progressive the next evening, filing an insurance claim. By doing so, the agent says Browning obtained insurance on the 1995 Dodge Ram after the damage to the vehicle had occurred, in order to fix the damage sustained to the vehicle. By doing so, Browning submitted an insurance claim, knowing the damage had occurred when the vehicle was not covered by insurance. Browning was charged with insurance fraud, a class D felony. If convicted, he could face up to five years in prison.

Georgia woman accused of arson, insurance fraud in Hall County fire. Jamie Renee Millsap was arrested and charged with arson Friday following an August fire investigation at Saddlehorse Drive in Hall County. Millsap was charged with arson in the first degree, fraudulent insurance claims and reckless conduct. The allegations: The fire occurred on Aug. 29 at about 4 a.m. Hall County Fire Rescue responded to reports of a residential fire in the 6200 block of Saddlehorse Drive and found the single-story residence fully involved. They began a defensive attack on the fire using aerial operations. The residents were not home at the time, and the primary search confirmed the house was clear. Despite efforts to control the blaze, the home was extensively damaged and considered a total loss. The investigation was aided by K-9 Apollo from the Hall County Fire Marshal’s Office and the Hall County Sheriff’s Office.

Florida clinic workers arrested for fake care they never provided after a staged car accident. Police in Miami-Dade say two women turned a small accident clinic in Doral into a front for insurance fraud. Valentina Villa Del Gordo and Sonia Villa Mizarvera were arrested this month and charged with racketeering, filing false insurance claims, organized fraud, and grand theft. The allegations: Investigators say the pair worked at Calama Accident Care Center. They allegedly used the clinic to bill an insurance company for physical therapy and other medical treatments that were never provided.The case stems from a staged car crash in May involving two men who police believe were in on the insurance scam. Once the fake car accident was on record, investigators say Del Gordo and Mizarvera submitted fraudulent paperwork to the insurer. The conspirators even used blank and post-dated forms signed by the supposed “patients.” On paper, it looked like a legitimate recovery process. In reality, no one had been treated.

   
    The Coalition Against Insurance Fraud is
    pleased to welcome Becker & Company
    into our community of industry leaders.
 

As a premier nationwide private investigation firm, Becker & Company has set the standard for excellence with family ownership and stewardship dating back to 1994. Their motto, “Small business values, nationwide footprint,” perfectly encapsulates their hands-on approach and broad capabilities.
 

Becker & Company delivers comprehensive solutions that help insurers across the United States safeguard against the threat of insurance fraud. Their network of over 450 W2 investigators discreetly monitors claimants and captures high quality video evidence, uncovering inconsistencies and establishing behavioral patterns that support strong legal defenses. Their extraordinary video capture rates, 82% in manned and 88% in unmanned surveillance, demonstrate a track record of reliable results. Desk investigations further strengthen the process, using advanced database tools and open source intelligence to produce detailed, courtroom ready reports.
 

Supporting these efforts, Becker & Company’s Claims Investigation Unit and Special Investigative Unit address a full spectrum of suspicious claims. By accelerating case resolutions, these units help insurers reduce costs, streamline processes, and prevent unwarranted payouts. Becker & Company also stands out for its commitment to education, offering complimentary seminars and continuing education programs to keep claims professionals at the forefront of fraud detection and investigative best practices.

Their team’s expertise includes assisting clients with state reporting requirements and regulatory compliance, ensuring insurers can meet all necessary legal standards with efficiency and integrity.
 

Becker & Company’s multifaceted approach promotes ethical practices and delivers real value to the insurance industry. The Coalition looks forward to a mutually beneficial relationship for years to come.

• Register to receive information about the GIFS and attend their Report to the Nations conducted in June of each year by using this link to establish your membership log-in credentials.
• Once you are approved, you are then invited to create your own professional profile on the Global Insurnace Fraud Directory. This is the first-ever world-wide listing of insurance fraud professionals. Only viewable by registered members of the GIFS, the Directory is open to all anti-fraud professionals including insurers, regulators, law enforcement and professional service providers.
• This year's Global Summit will be in Toronto Canada from October 19-22. Attendance at the Summit is by invitation only. If you are interested in being a part of this, or future, Global Summits you are welcome to submit an application. Summit sponsorships are still available which include 2 complimentary registrations. To find out more about becoming a sponsor just send an email to director@globalfraud.org.