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Insurance fraud has reached epidemic levels in the UK. | 0:00:05 | 0:00:09 | |
It's costing us more than £1.3 billion every year. | 0:00:09 | 0:00:14 | |
That's almost 3.6 million every day. | 0:00:14 | 0:00:17 | |
Deliberate crashes, bogus personal injuries, even phantom pets. | 0:00:19 | 0:00:24 | |
The fraudsters are risking more and more to make a quick killing | 0:00:26 | 0:00:30 | |
and, every year, it is adding around £50 to your insurance bill. | 0:00:30 | 0:00:34 | |
But insurers are fighting back, | 0:00:34 | 0:00:36 | |
exposing just under 15 fake claims every hour. | 0:00:36 | 0:00:39 | |
Armed with covert surveillance systems... | 0:00:39 | 0:00:41 | |
Subject out of the vehicle. | 0:00:41 | 0:00:44 | |
..sophisticated data analysis techniques... | 0:00:44 | 0:00:46 | |
..and a number of highly-skilled police units... | 0:00:49 | 0:00:51 | |
Stay where you are! | 0:00:51 | 0:00:53 | |
..they're catching the criminals red-handed. | 0:00:53 | 0:00:55 | |
Just don't lie to us. | 0:00:55 | 0:00:56 | |
All those conmen, scammers and cheats on the fiddle | 0:00:58 | 0:01:01 | |
are now caught in the act and claimed and shamed. | 0:01:01 | 0:01:04 | |
A flashy fraudster shows off his ill-gotten gains... | 0:01:11 | 0:01:15 | |
Exotic foreign holidays, exotic cars, | 0:01:15 | 0:01:18 | |
we've identified £80,000 plus that couldn't be accounted for. | 0:01:18 | 0:01:23 | |
It's a family affair, as one scammer steals from her own grandmother. | 0:01:23 | 0:01:27 | |
This was so premeditated. | 0:01:27 | 0:01:29 | |
I should imagine she's extremely unpopular in her family. | 0:01:29 | 0:01:33 | |
And one claimant develops a very convenient case of amnesia. | 0:01:33 | 0:01:37 | |
If you're a 17-year-old trying to get insurance on your first car, | 0:01:46 | 0:01:50 | |
the premiums can be eye-wateringly expensive - | 0:01:50 | 0:01:53 | |
well over £2,000 a year. | 0:01:53 | 0:01:55 | |
And it goes up from there if you happen to be male, | 0:01:55 | 0:01:58 | |
so if a broker offered you a much lower price, | 0:01:58 | 0:02:01 | |
you can see why the temptation would be there to go for it, | 0:02:01 | 0:02:04 | |
even if you thought it all sounded a bit too good to be true. | 0:02:04 | 0:02:07 | |
It's these sorts of high-risk individuals that so-called | 0:02:10 | 0:02:13 | |
ghost brokers target, as Clare Lunn | 0:02:13 | 0:02:15 | |
from insurance providers LV explains. | 0:02:15 | 0:02:17 | |
A ghost broker is an individual or group of individuals who set up | 0:02:19 | 0:02:23 | |
policies for the general public, | 0:02:23 | 0:02:25 | |
deliberately misrepresenting the risk to obtain cheaper premiums. | 0:02:25 | 0:02:30 | |
So, a ghost broker might sell a policy to a 17-year-old, | 0:02:30 | 0:02:33 | |
but get a cheap price, by telling the insurer | 0:02:33 | 0:02:36 | |
it's for an older, lower-risk driver. | 0:02:36 | 0:02:38 | |
The ghost broker then pockets the difference between what the policy | 0:02:38 | 0:02:42 | |
costs and what he charged the 17-year-old. | 0:02:42 | 0:02:44 | |
What's more, the insurance policy would be worthless, | 0:02:44 | 0:02:47 | |
leaving the 17-year-old uncovered. | 0:02:47 | 0:02:50 | |
In the worst-case scenario, | 0:02:50 | 0:02:52 | |
someone who's been a victim of a ghost broker can be driving around | 0:02:52 | 0:02:56 | |
in a vehicle, thinking that they're actually insured, | 0:02:56 | 0:02:59 | |
when the policy has been cancelled and they're driving uninsured. | 0:02:59 | 0:03:03 | |
Back at the start of 2013, | 0:03:05 | 0:03:07 | |
LV started to get suspicious that they were being targeted by a ghost | 0:03:07 | 0:03:11 | |
broker. They noticed some startling similarities in the details | 0:03:11 | 0:03:15 | |
of some of their motor insurance policies. | 0:03:15 | 0:03:17 | |
There were some key factors that linked these policies together. | 0:03:19 | 0:03:23 | |
These were the use of bank accounts and foreign cards which had been | 0:03:23 | 0:03:29 | |
compromised and also e-mail addresses | 0:03:29 | 0:03:33 | |
and a common occupation of accountancy. | 0:03:33 | 0:03:37 | |
During the investigations into the e-mail addresses and bank accounts | 0:03:38 | 0:03:42 | |
that had been used on several different policies, | 0:03:42 | 0:03:45 | |
one name kept cropping up - a Mr Abdulatif. | 0:03:45 | 0:03:47 | |
At first, LV were only suspicious about a few motor policies, | 0:03:49 | 0:03:53 | |
but once they knew what and who to look for, | 0:03:53 | 0:03:56 | |
the scale of the fraud escalated. | 0:03:56 | 0:03:59 | |
Originally, this started off as three policies, | 0:03:59 | 0:04:02 | |
but it very quickly grew and it was, in fact, the fastest-growing | 0:04:02 | 0:04:06 | |
fraud ring in LV's history, until it reached nearly 700 policies. | 0:04:06 | 0:04:11 | |
With suspected fraud on a level this vast, | 0:04:11 | 0:04:14 | |
LV got in touch with IFED. | 0:04:14 | 0:04:17 | |
IFED is the City of London Police's | 0:04:19 | 0:04:21 | |
Insurance Fraud Enforcement Department - | 0:04:21 | 0:04:24 | |
a dedicated team of detectives | 0:04:24 | 0:04:26 | |
committed to stopping insurance fraud cheats. | 0:04:26 | 0:04:29 | |
There is ever-more sophisticated | 0:04:30 | 0:04:32 | |
detection tools being used by the industry. | 0:04:32 | 0:04:34 | |
We're getting more and more cases every day. | 0:04:34 | 0:04:36 | |
This elite squad has prevented millions of pounds from being paid | 0:04:39 | 0:04:42 | |
out to criminals in fraudulent claims. | 0:04:42 | 0:04:44 | |
From now on, insurance cheats need to look over their shoulders. | 0:04:44 | 0:04:48 | |
It's all fraud, it's all crime and it can all lead to prison. | 0:04:49 | 0:04:53 | |
Police, don't move, stay where you are! | 0:04:53 | 0:04:55 | |
Police Sergeant Steven Holland works for IFED. | 0:04:57 | 0:05:00 | |
Once the team took up the case of the suspected ghost broker, | 0:05:00 | 0:05:03 | |
their first port of call | 0:05:03 | 0:05:04 | |
was to start investigating the prime suspect... | 0:05:04 | 0:05:07 | |
..Mr Abdulatif. | 0:05:09 | 0:05:10 | |
The initial investigation starts | 0:05:11 | 0:05:13 | |
with some financial investigation work which highlighted that | 0:05:13 | 0:05:17 | |
Mr Abdulatif is earning money through illegitimate sources, | 0:05:17 | 0:05:21 | |
we believe. He stated his occupation was a trainee estate agent | 0:05:21 | 0:05:25 | |
and also a courier. However, we've identified £80,000-plus | 0:05:25 | 0:05:29 | |
of money going to the account that couldn't be accounted for. | 0:05:29 | 0:05:33 | |
They also undertook a social networking search | 0:05:34 | 0:05:37 | |
and were utterly astonished at what they found. | 0:05:37 | 0:05:40 | |
Mr Abdulatif was enjoying luxuries well beyond the means of a trainee | 0:05:40 | 0:05:44 | |
estate agent. He'd posted countless | 0:05:44 | 0:05:47 | |
photos of himself all over his social media pages, | 0:05:47 | 0:05:50 | |
flaunting his wealth and expensive tastes. | 0:05:50 | 0:05:53 | |
It shows Mr Abdulatif living a champagne lifestyle. | 0:05:55 | 0:06:00 | |
Exotic foreign holidays. | 0:06:00 | 0:06:01 | |
Exotic cars. | 0:06:02 | 0:06:03 | |
Something that we wouldn't put together with | 0:06:05 | 0:06:08 | |
a trainee estate agent's salary. | 0:06:08 | 0:06:10 | |
Everything indicated towards us that Mr Abdulatif was involved in the | 0:06:12 | 0:06:15 | |
ghost broking and he was our initial and only suspect. | 0:06:15 | 0:06:18 | |
If this wasn't proof enough, | 0:06:22 | 0:06:24 | |
the investigation uncovered further undeniable evidence | 0:06:24 | 0:06:28 | |
that Mr Abdulatif was, indeed, a ghost broker. | 0:06:28 | 0:06:30 | |
We found over 100 text messages, in relation to offering and asking | 0:06:32 | 0:06:38 | |
to supply fraudulent insurance. | 0:06:38 | 0:06:41 | |
We also seized a laptop and, within that, we found several insurance | 0:06:41 | 0:06:45 | |
companies, certificates of insurance, which he was obviously | 0:06:45 | 0:06:49 | |
doctoring to provide to the people who were buying the insurance | 0:06:49 | 0:06:52 | |
policies, but they were all fraudulent. | 0:06:52 | 0:06:54 | |
And a lot of unsuspecting people | 0:06:55 | 0:06:57 | |
were buying their car insurance through | 0:06:57 | 0:07:00 | |
this particularly showy fraudster. | 0:07:00 | 0:07:02 | |
Mr Abdulatif was making money through either selling | 0:07:02 | 0:07:05 | |
fraudulent insurance policies | 0:07:05 | 0:07:07 | |
to members of the public and they would pay him and that money | 0:07:07 | 0:07:10 | |
would go into his own bank account, | 0:07:10 | 0:07:12 | |
or alternatively, he was phoning the insurance companies directly | 0:07:12 | 0:07:15 | |
and paying for these policies with compromised bank cards | 0:07:15 | 0:07:19 | |
or compromised bank account details. | 0:07:19 | 0:07:22 | |
The policies paid for by these fake or fraudulently-acquired bank cards | 0:07:22 | 0:07:26 | |
would quickly be cancelled by the insurance company, | 0:07:26 | 0:07:29 | |
but of course, Abdulatif wouldn't tell his clients this, | 0:07:29 | 0:07:32 | |
so many were driving around totally unaware that they had | 0:07:32 | 0:07:36 | |
no car insurance whatsoever. | 0:07:36 | 0:07:38 | |
If one of these fraudulent insurance policyholders were in an accident, | 0:07:39 | 0:07:43 | |
unfortunately, their policy would be worthless. | 0:07:43 | 0:07:45 | |
Mr Abdulatif took advantage of innocent members of the public | 0:07:48 | 0:07:51 | |
who paid him for their car insurance, | 0:07:51 | 0:07:53 | |
but ended up with either no motor policy, at all, | 0:07:53 | 0:07:56 | |
or a totally-invalid insurance policy. | 0:07:56 | 0:07:59 | |
But this wasn't as low as this greedy fraudster would go. | 0:07:59 | 0:08:03 | |
Mr Abdulatif realised that he could make even more money by selling | 0:08:03 | 0:08:07 | |
insurance to the otherwise uninsurable. | 0:08:07 | 0:08:09 | |
Mr Abdulatif was selling these policies to either genuine members | 0:08:11 | 0:08:14 | |
of the public who thought they were buying insurance, | 0:08:14 | 0:08:17 | |
but we also noticed a proportion of these policies going to known | 0:08:17 | 0:08:20 | |
criminals and to criminals who had either been disqualified from | 0:08:20 | 0:08:24 | |
driving, for offences such as drink-driving, or totting up points | 0:08:24 | 0:08:29 | |
for things like no insurance. | 0:08:29 | 0:08:31 | |
That's right. | 0:08:31 | 0:08:32 | |
Thanks to Mr Abdulatif, | 0:08:32 | 0:08:34 | |
banned drunk drivers were getting back behind the wheel. | 0:08:34 | 0:08:37 | |
To provide these disqualified drivers with motor policies, | 0:08:38 | 0:08:41 | |
he would simply forget to tell the insurance company that these people | 0:08:41 | 0:08:45 | |
had convictions, in the hope they wouldn't check. | 0:08:45 | 0:08:47 | |
But they did. | 0:08:49 | 0:08:50 | |
Despite thinking he was untouchable, the police arrested Mr Abdulatif. | 0:08:51 | 0:08:55 | |
And in October 2015, he was tried at the Old Bailey. | 0:08:56 | 0:09:00 | |
We had a really strong case with all the evidence that we seized and that | 0:09:01 | 0:09:07 | |
we went through and it showed | 0:09:07 | 0:09:09 | |
Mr Abdulatif provided fraudulent insurance policies | 0:09:09 | 0:09:12 | |
to various members of the public. | 0:09:12 | 0:09:15 | |
Mr Abdulatif pleaded guilty to 18 charges of fraud. | 0:09:15 | 0:09:20 | |
He had made over £100,000 from his criminal activities. | 0:09:20 | 0:09:24 | |
Abdulatif was sentenced to three years behind bars and given | 0:09:26 | 0:09:30 | |
a confiscation order, | 0:09:30 | 0:09:31 | |
meaning that almost all of the money will be recovered. | 0:09:31 | 0:09:34 | |
Still to come... | 0:09:42 | 0:09:44 | |
A cyclist has a lucky escape, after colliding with not one, | 0:09:45 | 0:09:49 | |
but two large metal objects. | 0:09:49 | 0:09:51 | |
The cyclist has flown around the outside. He's just tried to get | 0:09:51 | 0:09:54 | |
through this gap. There's no way he's going to get through that. | 0:09:54 | 0:09:57 | |
True enough, he doesn't get through. | 0:09:57 | 0:10:00 | |
And a woman lands herself in hot water, when her claim for a leak | 0:10:00 | 0:10:03 | |
goes down the pan. | 0:10:03 | 0:10:05 | |
Now, on our busy city centre roads there is a constant battle between | 0:10:14 | 0:10:18 | |
cyclists and buses. | 0:10:18 | 0:10:20 | |
Bus drivers say cyclists take unnecessary risks, | 0:10:20 | 0:10:23 | |
and cyclists are adamant that bus drivers are not vigilant enough | 0:10:23 | 0:10:27 | |
behind the wheel. One thing is for certain, though - | 0:10:27 | 0:10:30 | |
when collisions DO happen between a 20-tonne bus and a bike, | 0:10:30 | 0:10:33 | |
there is no contest about who comes off worse. | 0:10:33 | 0:10:37 | |
And tragically, according to the latest figures, | 0:10:37 | 0:10:39 | |
around 3,500 people are seriously injured or killed every year | 0:10:39 | 0:10:44 | |
on their bikes. | 0:10:44 | 0:10:46 | |
Lee Ingram works as a claims team manager for FirstGroup | 0:10:53 | 0:10:56 | |
and it's his job to make sure that if any one of his fleet of over | 0:10:56 | 0:10:59 | |
6,000 buses cause an injury or an accident, | 0:10:59 | 0:11:02 | |
the right people get compensated. | 0:11:02 | 0:11:04 | |
FirstGroup run many buses around the country, | 0:11:06 | 0:11:09 | |
covering a lot of distance on a lot of different types of roads. | 0:11:09 | 0:11:13 | |
Naturally, in busy city centres, | 0:11:13 | 0:11:15 | |
we also share those roads with not just other vehicles, | 0:11:15 | 0:11:18 | |
but with pedestrians and cyclists. | 0:11:18 | 0:11:20 | |
Lee dealt with one case in a town centre, where a cyclist | 0:11:22 | 0:11:25 | |
was knocked off his bike by a bus. | 0:11:25 | 0:11:27 | |
In this case, fortunately, it wasn't fatal, | 0:11:30 | 0:11:32 | |
but it was quite a serious accident that we had to investigate. | 0:11:32 | 0:11:35 | |
The claimant in this particular instance was alleging that he was | 0:11:35 | 0:11:39 | |
travelling in a designated lane. | 0:11:39 | 0:11:41 | |
He was turning right at a box junction, | 0:11:41 | 0:11:44 | |
and one of our buses had come from behind him | 0:11:44 | 0:11:47 | |
and, as it was passing him, | 0:11:47 | 0:11:48 | |
it has clipped his arm, forcing him to careen off the bus. | 0:11:48 | 0:11:52 | |
Unfortunately, there's an electrical junction box ahead of him | 0:11:52 | 0:11:57 | |
and he smashed into this junction box. | 0:11:57 | 0:11:59 | |
So, he's been unfortunate enough to be hit by a bus | 0:11:59 | 0:12:03 | |
and then he's been forced into an immovable metal object. | 0:12:03 | 0:12:07 | |
A serious accident. | 0:12:07 | 0:12:09 | |
And, as expected, the unfortunate cyclist claimed to have sustained | 0:12:09 | 0:12:12 | |
a number of injuries. | 0:12:12 | 0:12:13 | |
So, he's suffered some cuts to his hands, injured his wrist, his arms, | 0:12:16 | 0:12:22 | |
his shoulders, his neck, his lower back, he's got headaches. | 0:12:22 | 0:12:27 | |
The trauma of being hit by a bus or shunted into this object, | 0:12:27 | 0:12:31 | |
has caused him to have flashbacks, insomnia. | 0:12:31 | 0:12:34 | |
He's claiming a temporary loss of vision. | 0:12:34 | 0:12:37 | |
So, a wide range of injuries, | 0:12:37 | 0:12:39 | |
valuing at probably around £15,000 to £20,000 | 0:12:39 | 0:12:43 | |
worth of damages on his claim alone. | 0:12:43 | 0:12:46 | |
Given the gravity of the incident, | 0:12:47 | 0:12:48 | |
the first thing Lee and his team did was to speak to the witnesses. | 0:12:48 | 0:12:52 | |
And, you guessed it, there was a busload of them. | 0:12:52 | 0:12:55 | |
You've got the driver. | 0:12:57 | 0:12:58 | |
Obviously, you've got to question what they've done. | 0:12:58 | 0:13:01 | |
Remember, this is a bus carrying passengers - | 0:13:01 | 0:13:03 | |
always guaranteed to have plenty of witnesses. | 0:13:03 | 0:13:05 | |
So, every single one of those we're going to want to check, | 0:13:05 | 0:13:08 | |
to see if their version of events | 0:13:08 | 0:13:09 | |
matches with the claimant's version of events. | 0:13:09 | 0:13:12 | |
And in this case, they didn't. The passengers' accounts of what | 0:13:12 | 0:13:16 | |
happened put a huge dent in the cyclist's story. | 0:13:16 | 0:13:19 | |
They felt the driver of the bus | 0:13:19 | 0:13:20 | |
was driving in a perfectly-normal manner. | 0:13:20 | 0:13:23 | |
No evidence that he was driving too fast. | 0:13:23 | 0:13:26 | |
In comparison to that, they did feel that the cyclist | 0:13:26 | 0:13:29 | |
was going way too fast for the conditions. | 0:13:29 | 0:13:32 | |
Certainly trying to squeeze through a gap, just as the bus has started | 0:13:32 | 0:13:36 | |
moving forward and the witnesses themselves did actually feel | 0:13:36 | 0:13:40 | |
that the cyclist was responsible for the collision. | 0:13:40 | 0:13:43 | |
With these differing accounts, | 0:13:43 | 0:13:45 | |
Lee and his team focused in on the CCTV cameras fitted on the bus. | 0:13:45 | 0:13:49 | |
And the footage confirmed the witnesses' version of events, | 0:13:51 | 0:13:54 | |
NOT the cyclist's. | 0:13:54 | 0:13:55 | |
It showed the cyclist speeding alongside the bus. | 0:13:57 | 0:14:00 | |
It turns right and then attempts to squeeze past through a tiny gap | 0:14:00 | 0:14:04 | |
between the bus and the curb. | 0:14:04 | 0:14:06 | |
The cyclist has flown around the outside | 0:14:07 | 0:14:10 | |
and there's no way he can see ahead of him. | 0:14:10 | 0:14:13 | |
He's just tried to get through this gap. | 0:14:13 | 0:14:15 | |
There's no way he's going to get through that, and true enough, | 0:14:15 | 0:14:18 | |
he doesn't get through that. | 0:14:18 | 0:14:20 | |
It is a nerve-racking watch, | 0:14:20 | 0:14:22 | |
as the CCTV footage captures the moment of impact. | 0:14:22 | 0:14:25 | |
Keep your eye on the top right-hand corner of the screen. | 0:14:25 | 0:14:29 | |
It was clear that it was the cyclist's own reckless actions | 0:14:29 | 0:14:32 | |
that caused him to crash into the electrical box. | 0:14:32 | 0:14:34 | |
This guy could have been horrendously injured. | 0:14:36 | 0:14:39 | |
If he'd gone under that bus, his injuries could have been | 0:14:39 | 0:14:42 | |
very serious, if not fatal. | 0:14:42 | 0:14:44 | |
And all from an accident that could have easily been avoided. | 0:14:44 | 0:14:47 | |
For Lee and his team, the CCTV evidence brought the cyclist's claim | 0:14:48 | 0:14:52 | |
crashing to the ground. | 0:14:52 | 0:14:53 | |
We promptly went back to his solicitors and said, | 0:14:53 | 0:14:55 | |
"We're not paying this claim, for these reasons. | 0:14:55 | 0:14:58 | |
"We don't think we were at fault. | 0:14:58 | 0:15:00 | |
"Your client obviously put themselves in a position of danger" | 0:15:00 | 0:15:04 | |
and we never heard back from them. | 0:15:04 | 0:15:07 | |
This was a nasty accident | 0:15:08 | 0:15:10 | |
and the collision with the electrical box must have been | 0:15:10 | 0:15:13 | |
particularly shocking for the cyclist, | 0:15:13 | 0:15:15 | |
who was lucky not to have suffered any serious injuries. | 0:15:15 | 0:15:19 | |
However, in this case, the cyclist had to take responsibility. | 0:15:19 | 0:15:22 | |
There can be conflict sometimes between cyclists and users of large | 0:15:22 | 0:15:26 | |
vehicles. Maybe there just needs to be a bit of tolerance between road | 0:15:26 | 0:15:29 | |
users, particularly cyclists and other vehicles, | 0:15:29 | 0:15:32 | |
to avoid far more serious events actually happening. | 0:15:32 | 0:15:35 | |
Family heirlooms are priceless. | 0:15:44 | 0:15:46 | |
Really, there's no insurance cover in the world that can account for | 0:15:46 | 0:15:49 | |
the sentimental value attached to items that have been handed down | 0:15:49 | 0:15:53 | |
through the generations. But of course, if something has | 0:15:53 | 0:15:56 | |
a financial value to it, as well as a sentimental one, | 0:15:56 | 0:15:59 | |
it makes perfect sense to make sure | 0:15:59 | 0:16:01 | |
it's included in your household insurance. | 0:16:01 | 0:16:04 | |
Companies like RSA provide exactly this sort of protection. | 0:16:06 | 0:16:11 | |
John Beadle heads up their counter-fraud department | 0:16:11 | 0:16:13 | |
and previously dealt with a customer who had taken out contents insurance | 0:16:13 | 0:16:16 | |
on her home. | 0:16:16 | 0:16:18 | |
This particular lady took out a household policy with us | 0:16:21 | 0:16:27 | |
and one of the specified items on | 0:16:27 | 0:16:29 | |
her policy for all-risk cover was an | 0:16:29 | 0:16:33 | |
emerald ring, | 0:16:33 | 0:16:34 | |
valued at £11,650. | 0:16:34 | 0:16:38 | |
So, an expensive piece of jewellery, | 0:16:40 | 0:16:42 | |
which also had a rich family history, | 0:16:42 | 0:16:44 | |
making it all the more valuable to the claimant. | 0:16:44 | 0:16:47 | |
The ring actually had come from her grandmother, | 0:16:47 | 0:16:51 | |
who had, in turn, been given it by her grandfather, | 0:16:51 | 0:16:54 | |
who had bought it for his wife when he came back from India. | 0:16:54 | 0:17:00 | |
A lovely little gem of a story, but it wasn't to have a happy ending. | 0:17:00 | 0:17:05 | |
A very short time after she took the policy out, she made a claim, | 0:17:05 | 0:17:09 | |
saying that the ring had slipped off her finger | 0:17:09 | 0:17:13 | |
and got lost while she was gardening. | 0:17:13 | 0:17:16 | |
Now, I've heard of having green fingers, | 0:17:16 | 0:17:18 | |
but wearing your grandma's emerald ring, worth over 11 grand, | 0:17:18 | 0:17:22 | |
whilst doing a spot of weeding seemed unlikely. | 0:17:22 | 0:17:25 | |
John and his team weren't altogether convinced by the granddaughter's | 0:17:25 | 0:17:28 | |
story, and asked her for further information. | 0:17:28 | 0:17:31 | |
She provided to us some photographs of her wearing the ring, | 0:17:31 | 0:17:37 | |
which, in itself, was quite curious, | 0:17:37 | 0:17:39 | |
the way the photographs had almost been purposefully done to show | 0:17:39 | 0:17:44 | |
the ring, and she produced a valuation for the ring, | 0:17:44 | 0:17:49 | |
which had actually only just been obtained | 0:17:49 | 0:17:52 | |
a relatively short while beforehand. | 0:17:52 | 0:17:55 | |
Something just wasn't ringing true about the story of the lost piece | 0:17:55 | 0:17:59 | |
-of jewellery. -I think there were a number of factors | 0:17:59 | 0:18:02 | |
that conspired together to make us suspicious of this claim. | 0:18:02 | 0:18:05 | |
The loss occurring so shortly after the policy had been taken out, | 0:18:05 | 0:18:11 | |
the photographs, the recent evaluation which had been obtained, | 0:18:11 | 0:18:17 | |
all added up to make us a little suspicious around the claim, | 0:18:17 | 0:18:21 | |
so we decided to investigate further. | 0:18:21 | 0:18:25 | |
And where better to get a few pearls of wisdom about the case than from | 0:18:26 | 0:18:30 | |
the original owner of the ring, the claimant's grandmother? | 0:18:30 | 0:18:34 | |
We spoke to the grandmother, who actually confirmed to us | 0:18:34 | 0:18:38 | |
that the ring belonged to her, | 0:18:38 | 0:18:40 | |
and hadn't been gifted to her granddaughter. | 0:18:40 | 0:18:43 | |
And, in fact, the ring was still in the possession of the grandmother. | 0:18:43 | 0:18:48 | |
She told us that the ring she hid in a secret place in her bedroom. | 0:18:48 | 0:18:56 | |
The plot thickens. | 0:18:56 | 0:18:57 | |
The ring wasn't lost, at all, but safe and sound in granny's house. | 0:18:57 | 0:19:02 | |
However, there was another mystery to solve. | 0:19:02 | 0:19:04 | |
Strangely enough, she did notice the ring missing recently, | 0:19:04 | 0:19:08 | |
for a relatively short period, | 0:19:08 | 0:19:10 | |
but the ring then reappeared back in its hiding place. | 0:19:10 | 0:19:15 | |
Very few people knew where granny hid her precious emerald ring. | 0:19:15 | 0:19:19 | |
Conveniently, her granddaughter did. | 0:19:19 | 0:19:22 | |
To John and his team, it was obvious | 0:19:22 | 0:19:24 | |
what their gold-digging customer had been up to. | 0:19:24 | 0:19:27 | |
The claimant had removed the ring | 0:19:27 | 0:19:30 | |
from her grandmother's hiding place... | 0:19:30 | 0:19:33 | |
..taken photos of it on her finger... | 0:19:35 | 0:19:38 | |
..and took a policy out with us | 0:19:39 | 0:19:41 | |
with the specific aim of making a claim for | 0:19:41 | 0:19:44 | |
the ring. Then, put the ring back where she had removed it from, | 0:19:44 | 0:19:49 | |
in her grandmother's bedroom. | 0:19:49 | 0:19:51 | |
They confronted their scamming customer with the facts they had | 0:19:52 | 0:19:55 | |
gleaned from her own relative. | 0:19:55 | 0:19:57 | |
She did try to withdraw the claim and cancel her policy, | 0:19:57 | 0:20:02 | |
but the circumstances around this | 0:20:02 | 0:20:04 | |
were so well thought-out that we decided | 0:20:04 | 0:20:07 | |
it was a case that we needed to refer to IFED | 0:20:07 | 0:20:10 | |
and that's what we did. | 0:20:10 | 0:20:12 | |
IFED were keen to take up the case, | 0:20:13 | 0:20:16 | |
and soon caught up with the claimant. | 0:20:16 | 0:20:18 | |
She received a caution... | 0:20:18 | 0:20:20 | |
..and, ultimately, we have now placed her on | 0:20:22 | 0:20:25 | |
the insurance fraud register, | 0:20:25 | 0:20:27 | |
which will cause her problems when she tries to get insurance | 0:20:27 | 0:20:31 | |
in the future. | 0:20:31 | 0:20:32 | |
But you'd hope that she was also getting a fair amount of comeuppance | 0:20:32 | 0:20:36 | |
closer to home. | 0:20:36 | 0:20:37 | |
I should imagine she's extremely unpopular in her family. | 0:20:37 | 0:20:41 | |
I mean, this was so premeditated, | 0:20:41 | 0:20:44 | |
and unbeknown to anybody else in her family, | 0:20:44 | 0:20:46 | |
she had ultimately embroiled them, in her attempt to obtain | 0:20:46 | 0:20:52 | |
quite a large amount of money. | 0:20:52 | 0:20:55 | |
This fraudster's golden plan to make a quick £11,650 | 0:20:55 | 0:21:00 | |
was quickly foiled by John and his team. | 0:21:00 | 0:21:03 | |
Coming up, a cat owner attempts to defraud her insurers, to pay for | 0:21:09 | 0:21:13 | |
the treatment of her precious pet's upset tummy. | 0:21:13 | 0:21:16 | |
As long as insurance policies exist, | 0:21:23 | 0:21:25 | |
there will always be people out there who try and abuse the system. | 0:21:25 | 0:21:29 | |
If an insurance company even has an inkling that something isn't quite | 0:21:29 | 0:21:33 | |
right with a claim, they can refer it up to specialist agents. | 0:21:33 | 0:21:37 | |
Agents like those employed at I-COG Claims Management, | 0:21:39 | 0:21:43 | |
whose staff is trained to analyse speech and behaviour patterns, | 0:21:43 | 0:21:46 | |
in order to expose those claimants | 0:21:46 | 0:21:48 | |
who may not be telling the whole truth. | 0:21:48 | 0:21:50 | |
One such claim was recently referred to Claire Mitten, | 0:21:52 | 0:21:55 | |
I-COG's highly-skilled Operations Director. | 0:21:55 | 0:21:58 | |
The case involves a man who claimed he'd been the victim of a mugging | 0:22:03 | 0:22:07 | |
in a park in Glasgow, in which his gold necklace | 0:22:07 | 0:22:10 | |
had been snatched from around his neck. | 0:22:10 | 0:22:13 | |
The total of the claim was £750. | 0:22:13 | 0:22:16 | |
He was claiming for a gold chain | 0:22:16 | 0:22:18 | |
which had a diamante boxing glove pendant attached to it. | 0:22:18 | 0:22:21 | |
Before we even got to speak to the insured, | 0:22:21 | 0:22:23 | |
he had three failed appointments, where he wouldn't answer our calls. | 0:22:23 | 0:22:27 | |
There were just so many concerns with it that we knew straightaway | 0:22:27 | 0:22:30 | |
that this was a really interesting claim to deal with. | 0:22:30 | 0:22:32 | |
It was fourth time lucky, | 0:22:32 | 0:22:34 | |
as Claire finally got through to the claimant, to get a blow-by-blow | 0:22:34 | 0:22:37 | |
account of the theft of his boxing-glove necklace. | 0:22:37 | 0:22:40 | |
Mm-hm. | 0:23:00 | 0:23:01 | |
Mm-hm. | 0:23:05 | 0:23:06 | |
Mm-hm. | 0:23:10 | 0:23:11 | |
So, a dramatic and frightening mugging, | 0:23:32 | 0:23:35 | |
the sort of attack that can leave its mark on the victim | 0:23:35 | 0:23:38 | |
both emotionally and physically. | 0:23:38 | 0:23:40 | |
To Claire, the lack of injuries | 0:24:18 | 0:24:19 | |
sustained by the claimant seemed unusual | 0:24:19 | 0:24:22 | |
for an attack this physical, | 0:24:22 | 0:24:23 | |
and especially given that a fairly thick necklace | 0:24:23 | 0:24:26 | |
had been pulled off his neck. | 0:24:26 | 0:24:28 | |
You would have thought that there would be some markings to the neck, | 0:24:29 | 0:24:33 | |
such as scratchings or bruising to the neck | 0:24:33 | 0:24:34 | |
where it had been ripped off. | 0:24:34 | 0:24:36 | |
When somebody has been attacked, more often than not they can | 0:24:56 | 0:24:59 | |
describe the offenders in great detail, | 0:24:59 | 0:25:01 | |
because they've been so close to them. | 0:25:01 | 0:25:03 | |
This insured was not able to give us any description, other than he was | 0:25:03 | 0:25:07 | |
a well-dressed junkie with yellow skin. | 0:25:07 | 0:25:10 | |
It seemed odd to Claire that the customer couldn't describe | 0:25:10 | 0:25:13 | |
his attacker well, but it was what he claimed happened | 0:25:13 | 0:25:16 | |
immediately after the attack that left his story on the ropes. | 0:25:16 | 0:25:20 | |
Rather than calling 999 or seeking any sort of help, | 0:25:20 | 0:25:24 | |
the claimant got into his car | 0:25:24 | 0:25:25 | |
and drove off to collect his wife from work, as normal. | 0:25:25 | 0:25:29 | |
The claimant went on to explain that, after he'd picked up his wife, | 0:26:05 | 0:26:08 | |
they did then go to their local police station, | 0:26:08 | 0:26:11 | |
to report the incident. | 0:26:11 | 0:26:12 | |
Even if you lost your chain in the park, rather than had it stolen, | 0:26:42 | 0:26:46 | |
you would still be given some sort of reference number from the police, | 0:26:46 | 0:26:48 | |
so this was really alarming. | 0:26:48 | 0:26:50 | |
The claimant was sticking to his story that he'd not been given | 0:27:19 | 0:27:22 | |
a crime reference number, but the staff at I-COG have | 0:27:22 | 0:27:25 | |
an expert knowledge of police systems and this gave Claire | 0:27:25 | 0:27:29 | |
the upper hand. The gloves were now off, as she challenged | 0:27:29 | 0:27:32 | |
her opponent further about his alleged written statement. | 0:27:32 | 0:27:36 | |
When we asked the insured if we were able to contact the police, | 0:28:06 | 0:28:09 | |
to get a copy of the statement that he made, | 0:28:09 | 0:28:11 | |
he actually softened his voice. He became very nervous and explained | 0:28:11 | 0:28:15 | |
that he didn't know what the police would be able to provide us with. | 0:28:15 | 0:28:19 | |
If you do report an incident like that to the police and you have | 0:28:19 | 0:28:21 | |
given a statement, then actually those reports and statements | 0:28:21 | 0:28:24 | |
need to be kept for at least 15 years. | 0:28:24 | 0:28:26 | |
There was one final inconsistency, in regards to the detail | 0:28:27 | 0:28:30 | |
of the fight in the park | 0:28:30 | 0:28:32 | |
that really packed the finishing punch to the validity of the case. | 0:28:32 | 0:28:36 | |
It was the claimant's wife who had initially rung the insurance company | 0:28:37 | 0:28:41 | |
to report her husband's mugging. But the version of events she told them | 0:28:41 | 0:28:45 | |
differed substantially to what the claimant had just told Claire. | 0:28:45 | 0:28:49 | |
Whether you make a claim that's worth £250 or a claim that is worth | 0:29:29 | 0:29:33 | |
£1 million, the claim is always going to be investigated | 0:29:33 | 0:29:35 | |
by the insurance company, and there's no way of thinking that, | 0:29:35 | 0:29:38 | |
just because it's a low-value claim, it's going to get paid out. | 0:29:38 | 0:29:41 | |
If it's not right, if the account doesn't add up, | 0:29:41 | 0:29:44 | |
if the information you've given doesn't add up, | 0:29:44 | 0:29:46 | |
then it will get investigated further. | 0:29:46 | 0:29:49 | |
And in this case, the claim didn't add up. | 0:29:49 | 0:29:51 | |
The inconsistencies and the fact there was no crime reference number | 0:30:02 | 0:30:06 | |
meant that Claire had no choice | 0:30:06 | 0:30:07 | |
but to recommend to the insurance company not to pay out a penny | 0:30:07 | 0:30:11 | |
for the alleged stolen chain. | 0:30:11 | 0:30:13 | |
Now, it's one of those things that none of us wants to be a victim of - | 0:30:21 | 0:30:25 | |
coming home to find a burst pipe has flooded your house. | 0:30:25 | 0:30:28 | |
Even a small leak can cost thousands. | 0:30:28 | 0:30:32 | |
And if you don't have the right insurance, | 0:30:32 | 0:30:34 | |
you'll be the one soaking up the costs. | 0:30:34 | 0:30:37 | |
David Berry is the Technical Fraud Manager for Lloyd's Bank Group. | 0:30:37 | 0:30:40 | |
His team recently dealt with a claim from a customer | 0:30:40 | 0:30:43 | |
with a home contents policy. | 0:30:43 | 0:30:45 | |
She called us on the 30th of October and reported to us that when she had | 0:30:47 | 0:30:51 | |
returned home after being out for most of the day, | 0:30:51 | 0:30:53 | |
she saw water pouring in through the ceiling in her bedroom. | 0:30:53 | 0:30:56 | |
According to the customer, the damage was extensive. | 0:31:14 | 0:31:17 | |
David recalls all the items that the customer was claiming for | 0:31:25 | 0:31:29 | |
and it's quite the list. | 0:31:29 | 0:31:30 | |
A mattress, an electric blanket, | 0:31:30 | 0:31:32 | |
the carpeting, the decorations in the room, | 0:31:32 | 0:31:35 | |
an iron. There was a hairdryer in the room as well and also a laptop. | 0:31:35 | 0:31:39 | |
All of those items were damaged by the water that was coming | 0:31:39 | 0:31:42 | |
through the ceiling. | 0:31:42 | 0:31:43 | |
The value of the claim was estimated at £2,200. | 0:31:44 | 0:31:48 | |
On closer inspection, it emerged that the policy had been taken out | 0:31:48 | 0:31:52 | |
only two weeks before the claim. | 0:31:52 | 0:31:54 | |
It's not unusual for customers to suffer losses so close to when | 0:31:55 | 0:31:59 | |
the policy's taken out, but it can occasionally raise some concerns, | 0:31:59 | 0:32:04 | |
particularly given the nature of the type of loss that's presented. | 0:32:04 | 0:32:07 | |
As part of the standard process, | 0:32:08 | 0:32:10 | |
the claims handler asked the customer to provide evidence | 0:32:10 | 0:32:13 | |
of the damage the leak has caused. | 0:32:13 | 0:32:15 | |
The customer obliged, and sent in photographs. | 0:32:28 | 0:32:30 | |
But little did she know these would end up sinking her claim. | 0:32:30 | 0:32:35 | |
When she produced that information, | 0:32:35 | 0:32:36 | |
we identified, from the properties within the digital photographs, | 0:32:36 | 0:32:41 | |
that they were actually taken in September. | 0:32:41 | 0:32:44 | |
A month before she claimed the leak had occurred. | 0:32:44 | 0:32:46 | |
Our customer couldn't explain that to us, and as a result, | 0:32:47 | 0:32:50 | |
we declined the claim on the grounds of fraud and cancelled the policy. | 0:32:50 | 0:32:53 | |
But there was worse to come. | 0:32:54 | 0:32:56 | |
As fraud had been detected, | 0:32:56 | 0:32:58 | |
David decided to refer the case up to IFED. | 0:32:58 | 0:33:00 | |
The police accepted that she had no previous history of, er, | 0:33:00 | 0:33:05 | |
inappropriate behaviour, no previous convictions or similar. | 0:33:05 | 0:33:08 | |
As a result, they felt it was appropriate to deal with the matter | 0:33:08 | 0:33:11 | |
by way of a police caution. | 0:33:11 | 0:33:12 | |
IFED may have been lenient in this case, | 0:33:12 | 0:33:15 | |
but the customer now has a criminal record. | 0:33:15 | 0:33:19 | |
If you're going to try and make a false claim, | 0:33:20 | 0:33:22 | |
you'd better make sure you have a watertight cover story. | 0:33:22 | 0:33:26 | |
Lloyds Bank insurance take matters of fraud extremely seriously, | 0:33:27 | 0:33:30 | |
and as a result of that, we hope to protect our honest customers. | 0:33:30 | 0:33:33 | |
Whether you're a dog lover | 0:33:42 | 0:33:44 | |
or it's cats that make you weak at the knees, | 0:33:44 | 0:33:46 | |
if you love animals and have a pet, | 0:33:46 | 0:33:48 | |
they soon become part of the family. | 0:33:48 | 0:33:50 | |
Many people get a bit of a shock at the amount vets charge | 0:33:50 | 0:33:54 | |
for their services. Sadly, there is no NHS for animals. | 0:33:54 | 0:33:58 | |
Thankfully, though, there are companies, | 0:34:00 | 0:34:02 | |
like Agria Pet Insurance, that will provide cover for vets' bills. | 0:34:02 | 0:34:06 | |
Back in 2014, | 0:34:06 | 0:34:07 | |
Simon Wheeler dealt with a case involving owners who had taken out | 0:34:07 | 0:34:10 | |
a policy for their Ragdoll cat. | 0:34:10 | 0:34:13 | |
This rather beautiful breed is renowned for its bright blue eyes | 0:34:13 | 0:34:17 | |
and affectionate nature. | 0:34:17 | 0:34:19 | |
CAT MEWS | 0:34:19 | 0:34:20 | |
The policyholder insured the pet on the 1st of December. | 0:34:20 | 0:34:24 | |
About 11 days after the policy started, | 0:34:24 | 0:34:28 | |
we got a notification from the policyholder that their Ragdoll | 0:34:28 | 0:34:32 | |
had suffered a bout of diarrhoea. | 0:34:32 | 0:34:35 | |
And we got a notification claim for probably around the £200 mark | 0:34:35 | 0:34:38 | |
would be coming in. | 0:34:38 | 0:34:40 | |
The poor moggy had come down with a bad case of the runs | 0:34:42 | 0:34:46 | |
and the owner had taken it to the vet for treatment. | 0:34:46 | 0:34:49 | |
The cat's illness may not have been pleasant, but the timing of it was. | 0:34:49 | 0:34:53 | |
All pet insurers insist on something called an exclusion, | 0:34:53 | 0:34:57 | |
or waiting period, before you can make a claim for your pet's illness. | 0:34:57 | 0:35:01 | |
This is to stop people from taking out cover | 0:35:01 | 0:35:03 | |
the moment they think their pet is sick. | 0:35:03 | 0:35:06 | |
Luckily, for the owner of this particular kitty, | 0:35:07 | 0:35:09 | |
the cat's illness started just one day | 0:35:09 | 0:35:12 | |
after they were allowed to put in the claim. | 0:35:12 | 0:35:14 | |
At the time that we received the claim, | 0:35:16 | 0:35:18 | |
the notification for the claim, | 0:35:18 | 0:35:19 | |
it was just outside the exclusion period for illness. | 0:35:19 | 0:35:22 | |
The dates all tied up. | 0:35:22 | 0:35:24 | |
So, to all intents and purposes, it seemed a valid claim. | 0:35:24 | 0:35:27 | |
The owner must have felt like the cat that got the cream, | 0:35:29 | 0:35:32 | |
knowing their vets' bill would be covered. | 0:35:32 | 0:35:35 | |
But as soon as Simon and his team were sent the paperwork, | 0:35:35 | 0:35:38 | |
they found a problem. | 0:35:38 | 0:35:39 | |
When we got the claim form, | 0:35:42 | 0:35:44 | |
we also received the full veterinary history from the vet | 0:35:44 | 0:35:47 | |
and, when we looked at the veterinary history, | 0:35:47 | 0:35:50 | |
we noticed the first signs of diarrhoea | 0:35:50 | 0:35:53 | |
and the first symptoms had been noted on the 4th of December, | 0:35:53 | 0:35:57 | |
so a long time before the policyholder had told us, | 0:35:57 | 0:36:01 | |
and certainly in the middle of the exclusion period | 0:36:01 | 0:36:04 | |
at the start of a policy for illness. | 0:36:04 | 0:36:06 | |
Simon and his team carefully examined the rest of the paperwork | 0:36:07 | 0:36:11 | |
and found something that really set the cat amongst the pigeons. | 0:36:11 | 0:36:15 | |
Not only did the policyholder | 0:36:15 | 0:36:17 | |
submit the wrong date in their part of the claim form, | 0:36:17 | 0:36:20 | |
they'd also filled in a date | 0:36:20 | 0:36:21 | |
on the veterinary part of the claim form | 0:36:21 | 0:36:23 | |
and put a Post-it note for the vet to say, if possible, | 0:36:23 | 0:36:27 | |
can you make the date the 11th of December or later, | 0:36:27 | 0:36:31 | |
otherwise this is unlikely to be covered. | 0:36:31 | 0:36:34 | |
This one Post-it note led to the entire claim coming unstuck. | 0:36:34 | 0:36:39 | |
It was blatant fraud. | 0:36:39 | 0:36:41 | |
The policyholder knew exactly what they were doing. | 0:36:41 | 0:36:45 | |
They knew that the condition of the diarrhoea wasn't covered, | 0:36:45 | 0:36:48 | |
that it occurred | 0:36:48 | 0:36:49 | |
within the exclusion period at the beginning of the policy. | 0:36:49 | 0:36:51 | |
They then tried to coerce, or persuade, the vet to support them, | 0:36:51 | 0:36:56 | |
in terms of getting a dishonest claim paid by the insurance company. | 0:36:56 | 0:37:00 | |
Unsurprisingly, Agria didn't pay out a penny for the treatment | 0:37:00 | 0:37:04 | |
of this cat's diarrhoea. | 0:37:04 | 0:37:06 | |
It's very common for vets to talk to us about claims | 0:37:06 | 0:37:09 | |
and for us to talk to vets about claims, when we receive them. | 0:37:09 | 0:37:13 | |
In this instance, I think the policyholder | 0:37:13 | 0:37:16 | |
misjudged just what information would come in with the claim | 0:37:16 | 0:37:19 | |
and what would be on that information. | 0:37:19 | 0:37:21 | |
When doctors graduate from medical school, | 0:37:29 | 0:37:31 | |
they take an oath which states they have a duty to act in the best | 0:37:31 | 0:37:34 | |
interests of their patients. | 0:37:34 | 0:37:36 | |
But what if they don't? | 0:37:36 | 0:37:38 | |
What if a doctor was only motivated by personal gain? | 0:37:38 | 0:37:42 | |
Well, in America, individuals pay for their medical care, | 0:37:42 | 0:37:45 | |
so private health care insurance is a must. | 0:37:45 | 0:37:48 | |
But this can give unscrupulous physicians | 0:37:48 | 0:37:51 | |
the opportunity to commit fraud. | 0:37:51 | 0:37:53 | |
New York is renowned as the city that never sleeps | 0:37:57 | 0:38:01 | |
and its 20 million residents require round-the-clock health care. | 0:38:01 | 0:38:05 | |
Dr Spiros Paulos was an orthopaedic surgeon. | 0:38:05 | 0:38:08 | |
These specialists exclusively perform bone | 0:38:08 | 0:38:10 | |
or muscular-related operations. | 0:38:10 | 0:38:12 | |
He practised at a high-volume private medical centre | 0:38:13 | 0:38:16 | |
in New York state. | 0:38:16 | 0:38:17 | |
Spiros reportedly carried out thousands of surgeries | 0:38:21 | 0:38:24 | |
between 2006 and 2011, | 0:38:24 | 0:38:26 | |
and was performing up to and over 20 procedures every single day. | 0:38:26 | 0:38:31 | |
That's a staggering turnover for one doctor, | 0:38:33 | 0:38:36 | |
which some might say is an example of a man devoted to his job. | 0:38:36 | 0:38:40 | |
This couldn't have been further from the truth. | 0:38:42 | 0:38:45 | |
Dr Spiros Paulos's only devotion was to lining his own pockets. | 0:38:47 | 0:38:51 | |
He was conducting surgeries and carrying out procedures | 0:38:51 | 0:38:54 | |
his patients didn't need, | 0:38:54 | 0:38:56 | |
so he could submit false insurance claims, which would pay out | 0:38:56 | 0:39:00 | |
in excess of 13 million, over the course of his deception. | 0:39:00 | 0:39:04 | |
While he didn't directly receive payments from insurers, | 0:39:08 | 0:39:11 | |
the revenue he generated for the company | 0:39:11 | 0:39:13 | |
earned him massive pay-outs. | 0:39:13 | 0:39:15 | |
Paulos falsified medical records for procedures he never performed, | 0:39:21 | 0:39:25 | |
conducted surgery on patients that didn't need treatment | 0:39:25 | 0:39:28 | |
and would give patients the wrong operation, | 0:39:28 | 0:39:31 | |
so he could collect a bigger return from insurers. | 0:39:31 | 0:39:33 | |
He wasn't just abusing his position and violating a sacred trust | 0:39:38 | 0:39:42 | |
with these fake operations, | 0:39:42 | 0:39:43 | |
he was botching the surgery with shocking efficiency | 0:39:43 | 0:39:47 | |
and putting lives at risk. | 0:39:47 | 0:39:49 | |
One fragile 76-year-old woman went under his knife | 0:39:51 | 0:39:54 | |
for what should've been a routine procedure | 0:39:54 | 0:39:56 | |
to reconstruct her arthritic knee. | 0:39:56 | 0:39:59 | |
24 hours later, that woman was dead. | 0:39:59 | 0:40:02 | |
The coroner's report found a blood clot entering her lung | 0:40:08 | 0:40:11 | |
caused her death. | 0:40:11 | 0:40:13 | |
It also found that no evidence of any reconstructive knee surgery | 0:40:13 | 0:40:16 | |
had taken place. | 0:40:16 | 0:40:18 | |
He'd simply sliced her open and stitched her up, | 0:40:18 | 0:40:21 | |
so he could submit a claim to insurers. | 0:40:21 | 0:40:24 | |
He hadn't conducted any actual surgery on her knee. | 0:40:24 | 0:40:27 | |
But this Big Apple surgeon had bitten off more than he could chew | 0:40:32 | 0:40:35 | |
and it would be his sheer greed which would expose his lies. | 0:40:35 | 0:40:39 | |
Other surgeons at his company averaged 30 procedures per month. | 0:40:41 | 0:40:45 | |
Insurers' records showed Paulos | 0:40:45 | 0:40:47 | |
was doing nearly as many in a single day. | 0:40:47 | 0:40:49 | |
Naturally suspicious, | 0:40:52 | 0:40:53 | |
insurers took a closer look at the billing invoices | 0:40:53 | 0:40:55 | |
they'd been receiving. | 0:40:55 | 0:40:57 | |
This revealed he had falsified an alarming amount of documents. | 0:40:57 | 0:41:01 | |
Deeper investigations into procedures performed on patients | 0:41:02 | 0:41:05 | |
uncovered unusual amounts of repeated surgeries, | 0:41:05 | 0:41:08 | |
which didn't make any sense. | 0:41:08 | 0:41:11 | |
Paulos tried to claim the billing discrepancies | 0:41:12 | 0:41:15 | |
were a result of clerical error. | 0:41:15 | 0:41:17 | |
He even tried to blame his wife | 0:41:17 | 0:41:18 | |
for incorrectly transcribing patient records. | 0:41:18 | 0:41:22 | |
It would do him no good. | 0:41:22 | 0:41:24 | |
In July 2011, he was fired from his employer, | 0:41:24 | 0:41:27 | |
subsequently arrested and charged with one count of health care fraud. | 0:41:27 | 0:41:31 | |
Between 2006 and 2011, | 0:41:35 | 0:41:37 | |
it was estimated that Paulos had personally profited | 0:41:37 | 0:41:40 | |
to the tune of 7.5 million through his sickening scam. | 0:41:40 | 0:41:44 | |
Under interview, Paulos admitted, from 2008, | 0:41:50 | 0:41:53 | |
after only two years in the job, | 0:41:53 | 0:41:55 | |
he falsified records almost every time he performed surgery. | 0:41:55 | 0:41:59 | |
Paulos pleaded guilty to healthcare fraud | 0:42:02 | 0:42:04 | |
at White Plains Federal Court before a packed gallery. | 0:42:04 | 0:42:07 | |
Proceedings were watched | 0:42:08 | 0:42:09 | |
by a handful of patients he had unnecessarily operated on. | 0:42:09 | 0:42:13 | |
During the trial, Paulos read a statement to the court... | 0:42:14 | 0:42:17 | |
"I wish I could tell you I had noble motives for this, but I do not. | 0:42:17 | 0:42:22 | |
"I did this out of greed and insecurity." | 0:42:22 | 0:42:25 | |
He was sentenced to 4.5 years behind bars | 0:42:28 | 0:42:31 | |
and ordered to pay costs of 5.5 million | 0:42:31 | 0:42:33 | |
to the insurers he had defrauded. | 0:42:33 | 0:42:36 | |
But the criminal trial was just the beginning. | 0:42:37 | 0:42:40 | |
Now that he's been convicted, some 260 of his ex-patients | 0:42:41 | 0:42:45 | |
are bringing individual lawsuits against him | 0:42:45 | 0:42:48 | |
for all manner of abuses suffered under the knife | 0:42:48 | 0:42:51 | |
of Dr Paulos. | 0:42:51 | 0:42:52 | |
From organised criminal gangs to exaggerated household claims, | 0:43:00 | 0:43:04 | |
insurance fraud hits all of us in the pocket. | 0:43:04 | 0:43:07 | |
But instead of getting away with it, | 0:43:07 | 0:43:09 | |
more and more of these fraudsters are being claimed and shamed. | 0:43:09 | 0:43:14 |