July 1, 2005

Insurance Fraud: A is for Arson

High school chemistry teacher Tramesha Lashon Fox, 32, had a problem. Her 2003 Chevrolet Malibu was a bummer to drive, so she went out and bought a 2005 Toyota Corolla. Unfortunately, she still owed $20,000 on the Malibu. So she concocted a plan to get rid of the unwanted car: she recruited two of the worst students in her class (both were failing) to steal the car and burn it. At first they thought she was joking, but she persisted. On May 27, the last day of school, the students took the unlocked 2003 Chevrolet Malibu from a shopping mall, drove it to a wooded area and set it on fire. In return one received a grade of 90 on the final exam and the other 80. (I cannot help but wonder if the latter student complained:"Hey, how come I only got a "B"?)

This appears to be a fairly mind-boggling example of insurance fraud. Not only does a teacher abuse her position by recruiting her own students to perform a criminal act, she rewards them in a way that profoundly comprises her position as a teacher.

Where the Money is
The notorious bank robber Willie Sutton, when asked why he robbed banks, replied "because that's where the money is." Read the FBI's brief but pungent profile of Sutton's life here, and take note that at the end of his life Sutton was released from prison and endorsed a bank! (As they say in America, there's no such thing as bad publicity!)

For some people, insurance is simply "where the money is." The Insider recognizes that fraud exists and that it costs a lot of money. In workers comp, the opportunities for fraud arise in a number areas:
Employee fraud: outright faking of an injury -- which we think is relatively rare, although there are pros who are skilled at exploiting the system. The more significant problem is malingering -- employees with legitimate injuries who stay out of work far longer than the injury requires or for whom disability becomes a way of life.

When you "follow the money," fraud in workers comp is not generally flowing toward employees, but to other key players in the system:
Employer fraud: not securing comp coverage for employees; misclassifying employees; using "independent contractors" instead of employees; under-reporting payrolls; asking employees to file work-related injuries under regular health insurance.
Doctor fraud: billing for unnecessary services, billing for more expensive procedures than were provided or most blatantly, services which were never provided. .
Lawyer fraud: coaching employees in phony or exaggerated symptoms (they keep a supply of neck braces and crutches in the closet). Sending employees to colluding doctors, who perform unnecessary services and share the procedes with the lawyer.
State administrator fraud (did someone say "Ohio"?): misappropriating trust funds to benefit the politically connected.

This is not an exhaustive list. Here's an interesting website devoted to insurance fraud, complete with a year by year "Hall of Shame": you click on the jail cell and read the story of someone who got caught. She's innocent until proven guilty, but I wouldn't be surprised to see Tramesha Fox secure her own little cell in the 2005 archives and her own special place in the history of insurance fraud.

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About this Entry

This page contains a single entry by Jon Coppelman published on July 1, 2005 11:37 AM.

Heat stress: fluid and electrolite imbalance can be fatal was the previous entry in this blog.

Cell Phones and Driving: Headsets are Cheaper (But Not Safer) is the next entry in this blog.

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