Personal Injury Investigations
Personal injury cases take a toll on both businesses and individuals. Legitimate injuries caused by the negligence of businesses are needless tragedies, and businesses should recompense the injured adequately. Sometimes, however, unscrupulous persons construct fake accidents and sue businesses, hoping for settlements out of court. If they can manage this, there's usually no great spotlight on the details of the accident and injury. Furthermore, many companies find it less time consuming and much less expensive to pay someone who's threatening a lawsuit than to go to court.
The Slip and Fall Artist
The fact that companies make payoffs with very little investigation into the alleged injury is unfortunate because it can encourage someone with a larcenous bent to try for her piece of the personal injury pie. One notorious type is the slip and fall artist. This person creates the pretense of falling and being injured due to negligence on behalf of a business.
For example, Mr. Slip may enter a grocery store, wait until no one is watching, break a bottle from the store's shelf, and then pretend to slip on the bottle's contents. These people have also been known to bring their own water, oil, or similar liquid, pour it onto the floor of a business, and pretend to fall in it. Unless there are witnesses, it's extremely difficult to prove this con, but stores with adequate camera systems have caught this on tape.
Most stores and businesses don't have anything near an adequate camera system. The professional slip and fall artist knows how to scope out the system, finding holes within which she can operate. This is why the visible camera system by itself is inadequate. Adding hidden cameras would cover the business and catch the artist operating where she feels unobserved.
Investigators may be hired to film the claimant's daily activity in hopes of proving the con. Also, many investigators specialize in installing hidden camera systems, a lucrative specialty whose need grows with the rise in certain types of crimes such as the slip and fall and shoplifting. Cameras are also installed to guard against employee theft and to determine whether further training is needed.
Installing cameras may help business protect themselves against false lawsuits.
Medical Fraud
Doctors and other medical service providers are in a position, should they choose, to defraud insurance companies. While most do not, a large and growing number of medical professionals have chosen to make a side business of padding patients' bills. Even otherwise legitimate doctors have been known to do this occasionally in order to meet payroll or cover losses.
Most patients never scrutinize medical bills unless they're ridiculously long or more expensive than expected. Even when patients do study their bills, they're almost impossible to fully understand unless you work in the field. Medical criminals know this and count on it. Some medical service providers have learned to spread their fraudulent charges over a wide range of patients and dates. These professionals have also been known to charge for visits and services for patients who were never seen, keeping the patient from looking too closely into the transaction by having any refund sent to him. Because the patient benefits, many who realize what's going on just let it go. In this way, they're silent accomplices to fraud because they allow it to continue. Because of all these things, it's not unusual for patients to pay fraudulent medical claims for years before the deceit is discovered.
Other physicians insist that a personal injury claim be filed after an accident, even when the patient is uninjured. Another problem is that of suspect attorneys claiming that a client was injured on someone's property, when no one but witnesses she produces can verify the facts of the injury. These attorneys and cohorts have been known to deliberately stage accidents, destroy property, and fake injuries.
One of the worst problems in this area is accident-chasing attorneys. Since attorneys who appear at accident scenes have long been charged with the unflattering title of ambulance chasers, many use different tactics. One is to send cappers or runners to scenes in the guise of caring witnesses. Cappers direct injured parties to their bosses, unscrupulous doctors and/or attorneys.
Then there are the organized criminal enterprises that engage in fraudulent billing of insurance companies. Called mills, these enterprises bilk insurance companies, and by extension consumers, on a grand scale. Some of the most common mills are:
Those who routinely inflate bills
Those who double dip by overcharging and double charging
Those whose operation is phony from the doctor on down, and sometimes the attorney as well
Everyone pays for this crime. Entire clinics have been set up for the purpose of filing false claims. Patients with similar criminal inclinations are often paid to participate. When you know of fraudulent medical claims being filed, report it. Otherwise, that nice, new building that won't take your insurance may take cash from someone desperate for medical treatment, then provide him fraudulent services. Most places won't do this because it ratchets them up into the far more serious crime of treating patients without a license. Yet some have gone so far as to do this, and when the heat gets to be too much, they pack up and move to another location.
The PI will often go undercover as a patient or even employee of these physicians. In this way, she can obtain firsthand information to which she can testify. Surveillance of patients is also an option. Sometimes they can be convinced to testify against the physician or his billing staff in return for immunity from prosecution. This is a tricky situation, however, and must be handled carefully.
