Publications

The California Department of Insurance has issued an additional reminder that the 2024 SIU Annual Report must be filed by all carriers licensed and admitted to conduct insurance business in the state no later than 11:59 p.m. on Monday, September 15, 2025. The SIU Compliance Unit emphasized that no extensions will be granted and urged companies to complete their filings as soon as possible to avoid late submission issues. Reports marked “pending” in the portal have not yet been received by the Department and only those marked “submitted” are considered filed. Failure to meet this requirement could raise compliance concerns and potentially impact antifraud oversight. Coalition members doing business in California are encouraged to ensure their filings are complete and timely, reinforcing the shared commitment to robust SIU operations that support California’s fight against insurance fraud. For questions or assistance, insurers may contact the SIU Compliance Unit directly at SIU-AnnualReport@insurance.ca.gov.

The NAIC is developing a playbook to tackle homeowners insurance challenges, with fraud prevention built in. The National Association of Insurance Commissioners (NAIC) Property and Casualty Insurance Committee is putting together a new Homeowners Insurance Affordability and Availability Playbook, aiming to help state regulators address one of the toughest issues in today’s market. A final version is expected by the end of this year, but a draft has already been released. Stakeholders were invited to submit comments and those letters are now posted on the Committee’s webpage. What makes this especially relevant for fraud fighters is that the draft outline highlights consumer protection examples through fraud prevention. Efforts include current state initiatives to protect homeowners from contractor fraud, stronger consumer outreach and education programs, new licensing and oversight rules for adjusters to guard against abuse in the claims process, and the use of artificial intelligence to reduce fraudulent activity. In addition, some states are expanding partnerships across agencies to coordinate disaster recovery and tackle fraud risks head-on. These are the kinds of approaches that line up well with the Coalition’s priorities. The full draft playbook will be released later this year, and we’ll keep members updated on how fraud prevention continues to factor into this important project.

The Texas Department of Insurance (TDI) Fraud Unit announces reappointments to its Training Advisory Board. TDI's Fraud Unit Training Advisory Board, which oversees the development of insurance fraud training for law enforcement officers across the state, has confirmed its current roster of board members. Established under the Texas Administrative Code, the board includes representatives from law enforcement, the public, and ex-officio members from the Fraud Unit. Its role is to help govern the TDI Fraud Unit's efforts to train Texas peace officers in basic insurance fraud investigation who can act as force multipliers in the fight against insurance fraud in the Lone Star State. Coalition director of government relations Brent Walker was reappointed to a second three-year term. Thus far, TDI's Fraud Unit has trained Texas law enforcement officers from 45 different agencies with more planned in the future. This continued commitment reflects the critical need for well-informed anti-fraud law enforcement officers in Texas.

The insurance fraud watchdog analyzed thousands of questionable insurance claims submitted by policyholders to their insurance companies from 2022 through June 30, 2025, and found a significant year-over-year increase in claims where an element of either traditional identity theft or the use of a synthetic identity was found. Close to a quarter of the insurance claims processed that had identity theft as a reason for referral to NICB involved a synthetically generated identity. Synthetic identity theft is a newer form of identity crime that combines legitimate personally identifiable information, such as a social security number or date of birth, with fabricated information to create a new fake person or entity, making it difficult to identify and investigate. “Identity theft and the use of synthetic identities are the foundation for life insurance, medical-related fraud, and cargo theft,” said NICB President and CEO David J. Glawe. “The ever-changing digital environment, coupled with artificial intelligence, has enabled criminals to create bogus identities and pose as a deceased person’s beneficiary to collect life insurance payouts, submit false medical expenses to receive reimbursement, or even reroute goods for sale on the black market. Some thieves are creating fictitious business entities that use identity crimes as the underpinning of criminal activity that targets the insurance industry.” The NICB is currently piloting a machine-learning tool to flag questionable identities using anomalous identifier patterns and data aggregators to detect inconsistencies such as multiple dates of birth linked to a single social security number. Once flagged, investigators can intercept claims that may include a related identity theft.

New research shows young people are more willing to commit insurance fraud. If you're under the age of 34, you may be more willing to commit insurance fraud, according to a new University of Georgia research study. The new study suggests that the younger you are, the more likely you may be to deceive a company or adjuster to get desired funds or outcomes. But some fraudsters might not realize they’re committing a crime when they do. “Many people, especially younger people, have an adversarial relationship with insurance companies,” said the Coalition's Executive Committee Member, Brenda Cude, Ph.D., lead author of the study, and a professor emerita in the UGA College of Family and Consumer Sciences. “If you’re pushed into a position of thinking you need to fight, maybe that pushes people into actions that they wouldn’t otherwise consider, especially if they’re not aware that it’s technically illegal. There are lots of major consequences that could come from that.” We here at the Coalition are proud to know that, during this study researchers relied on data from our Studies, which surveyed almost 1,500 adults about their thoughts on insurance claims. Among other questions, the survey asked respondents if they would: Consider or had included damages that happened before a car accident on a claim (or if they had done so in the past), Leave out information or provide false information on an insurance application to get better coverage or a lower premium, Help a medical provider bill for treatment they hadn’t actually received and more.

FBI seeks victims in nationwide health insurance scam tied to Oregon case. The FBI is asking for help from individuals who may have been defrauded by Bene Market Group or its affiliated companies, as part of a national investigation into a health care fraud scheme with ties to Oregon. The request follows a 2024 cease-and-desist order from the Oregon Division of Financial Regulation (DFR) against Seguro Medico LLC—also known as Quick Health—and its partial owner, Arthur Walsh. DFR permanently revoked the company’s license, citing serious violations of the Oregon Insurance Code. According to the DFR, Seguro Medico and Walsh: Enrolled consumers in insurance plans without their knowledge, Sent misleading and inaccurate text messages, Used false statements in sales scripts, Falsified agent applications using Walsh’s credentials, Forged a former employee’s signature, Failed to report disciplinary actions in other states, Ignored inquiries and failed to update contact information with regulators. Victims or individuals with relevant information can complete a short online form at: https://forms.fbi.gov/victims/phhcftvictims. The FBI also asks consumers to email copies of any documents they received from Bene Market Group or its affiliates, along with any previous complaints, to phhcft@fbi.gov. Include your full name in the subject line.

Neil Hopper of Truro, Cornwall, carried out hundreds of amputation operations before having his own legs removed in 2019. Truro Crown Court heard he lied to insurers by claiming that injuries to his legs were the result of sepsis and not self-inflicted. It heard that in May 2019 Hopper had below knee amputations after a "mysterious illness". In fact he had used ice and dry ice to freeze his own legs so they had to be removed. The court heard Hopper, who admitted two counts of fraud and three of possessing extreme pornography, had a "sexual interest in amputation". The fraudulent insurance claims from two firms totaled more than £466,000, with prosecutors saying that Hopper had been tempted by "greed". He had messaged a friend about the claims saying he should "milk it", the court heard and how he "enjoyed" the interest from the media in his case. Former patients of Hopper, including some who underwent amputations, have contacted a South West-based medical negligence firm. They said they were concerned about the treatment they received from Hopper, in light of the criminal charges brought against him. Mike Bird, partner at Enable Law, said the case had caused "shock and grave concern" among his former patients. "Some have had life-changing surgery and are now worried it was not really needed." 

This week is also host to a whole crop of crop insurance fraud. Robert “Robbie” Thomas Hunt, 61, of Campbellsville, was sentenced to 12 months and 1 day in prison, followed by 2 years of supervised release in federal jail after he pleaded guilty to crop insurance fraud. Hunt sold crops under the names of other people and underreported true production on claim forms. This resulted in over $1.6 million in fraudulent insurance overpayments. This activity happened between 2014 and 2021. Hunt was ordered to pay restitution of $1,686,002 and was fined $250,000. Hunt will receive no parole in the federal system.

In addition, a second farmer and his family hit with fines for crop insurance fraud case. James and Levi Garrett – a father and son farming partnership – were convicted of crop insurance fraud, and now face their sentence as they are fined over $4 million dollars. The monetary penalty ordered by Chief U.S. District Judge Roberto Lange was meant to satisfy violations under the federal False Claims Act. “Protecting taxpayer-funded programs from fraud and abuse remains a top priority for our office,” Ramsdell said in a release, “and we won’t stop at criminal convictions. As this case demonstrates, those who attempt to cheat federal programs face serious consequences—both criminal and civil.”

Pennsylvania man facing felony charges for attempting to use a lapsed policy. Lamar Fisher was charged earlier this week and faces counts of felony insurance fraud, felony attempted theft by deception, felony criminal use of a communication device and misdemeanor insurance fraud. The allegations: Fisher’s 2019 Infiniti QX80 was damaged in a single-vehicle crash on Jan. 6, 2024, during snowy road conditions in Telford Borough. Fisher allegedly called 911 at 1:48 p.m. to report the accident. Investigators said his Progressive Insurance policy had lapsed weeks earlier due to nonpayment. Fisher reinstated the policy online at 1:42 p.m. that same day, minutes after the accident occurred, and signed a “Statement of No Loss” affirming the vehicle had not been damaged. At 2:08 p.m., he submitted an insurance claim and later provided photographs of the damaged vehicle. Investigators said metadata embedded in the photos revealed they were taken at 1:38 and 1:39 p.m., before the policy was reinstated. Progressive denied the claim on Jan. 18, 2024, citing misrepresentations and lack of coverage at the time of the crash. During interviews with investigators, Fisher allegedly admitted he reinstated his policy after the accident and confirmed the timing of the photographs.

Kansas woman sentenced to a year's probation for insurance fraud. Kenna Robinson, 50, pleaded guilty in the Douglas County District Court to one felony count of insurance fraud. Robinson involved multiple persons reporting false information during the claims process to an insurance company in attempts to get insurance coverage after the incident occurred. She pleaded guilty and was sentenced on Aug. 28 to 12 months probation with ten months underlying prison time if her probation is violated. Two others involved, Michaela Foster and Rylie Kelley, were previously sentenced in December of 2024, for their roles in this insurance fraud scheme.

A Minnesota attorney charged local roofing contractor with wage theft. Ramsey County Attorney John Choi on Wednesday announced multiple charges, which he said stem from a nearly yearlong multi-agency investigation, against three owners of Bayvista, Inc. The allegations: A subcontractor on a public housing project underpaid workers despite clearly knowing the actual pay rate, and seven workers cooperated and helped lead to these charges. However, officials believe there are around two dozen victims. While the investigation is still ongoing, Choi says the actions amounted to around $250,000 in stolen wages. In announcing the charges, Choi highlighted “the loss to the workers as well as what it does to the industry,” adding, “It’s just simply not fair that subcontractors can have these really low bids. I think as a society we need to think about that, that when we procure contracts, oftentimes the law talks about the lowest responsible bidder in these government contracts but what we really also need to be thinking about is the responsible aspect of the bidding process.”

• 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.