0:00:02 > 0:00:05Insurance fraud in the UK has hit epidemic levels.
0:00:05 > 0:00:08It's costing us over £1 billion every year.
0:00:08 > 0:00:10That's almost £3.5 million every day.
0:00:13 > 0:00:18Deliberate crashes, bogus personal injuries, even phantom pets.
0:00:19 > 0:00:23The fraudsters are risking more and more to make a quick killing
0:00:23 > 0:00:27and every year, it's adding over £50 to your insurance bill.
0:00:27 > 0:00:29But insurers are fighting back,
0:00:29 > 0:00:33exposing just under 15 fake claims every hour.
0:00:33 > 0:00:35Armed with covert surveillance systems...
0:00:35 > 0:00:38Subject out the vehicle.
0:00:38 > 0:00:40..sophisticated data analysis techniques...
0:00:42 > 0:00:45..and a number of highly skilled police units...
0:00:45 > 0:00:47Police, don't move, stay where you are.
0:00:47 > 0:00:49..they're catching the criminals red-handed.
0:00:49 > 0:00:51Just don't lie to us.
0:00:51 > 0:00:55All those conmen, scammers and cheats on the fiddle are now
0:00:55 > 0:00:58caught in the act and claimed and shamed.
0:01:04 > 0:01:08Today, car insurance fraud, a victim's story.
0:01:08 > 0:01:13I felt absolutely sick knowing that I'd been driving around uninsured
0:01:13 > 0:01:16all that time, one of the worst days of my life.
0:01:16 > 0:01:18A tall tale about a mugging is knocked back.
0:01:31 > 0:01:34And an American woman's appearance on national television leads
0:01:34 > 0:01:36to her come on down fall.
0:01:36 > 0:01:37Nice to see you.
0:01:43 > 0:01:45The City of London Police's
0:01:45 > 0:01:47Insurance Fraud Enforcement Department, or IFED,
0:01:47 > 0:01:49is a dedicated team of detectives,
0:01:49 > 0:01:52committed to stopping insurance fraud cheats.
0:01:52 > 0:01:56Since IFED started at the beginning of 2012,
0:01:56 > 0:02:001,200 individuals have been either arrested
0:02:00 > 0:02:03or interviewed under caution, suspected of insurance fraud.
0:02:04 > 0:02:07This elite squad has prevented millions of pounds being paid out
0:02:07 > 0:02:09to criminals in fraudulent claims.
0:02:09 > 0:02:13From now on, insurance cheats need to look over their shoulders.
0:02:13 > 0:02:16Insurance fraud isn't easy money. It has risks and consequences.
0:02:16 > 0:02:19You could get a criminal conviction and you can go to jail.
0:02:19 > 0:02:22Police, don't move, stay where you are!
0:02:22 > 0:02:25One particular problem is ghost broking.
0:02:26 > 0:02:29DS Mark Forster knows how this scam works only too well.
0:02:31 > 0:02:33Ghost broking is effectively the unlawful selling
0:02:33 > 0:02:35of insurance policies.
0:02:35 > 0:02:39It's done by criminals who will sell you false documents
0:02:39 > 0:02:43in the belief that you have bought legitimate insurance cover
0:02:43 > 0:02:44when, in fact, you haven't.
0:02:44 > 0:02:48The more sophisticated ghost brokers use inside knowledge
0:02:48 > 0:02:50of the industry to appear legitimate.
0:02:51 > 0:02:55But people like Alison Middleton of Tradewise know exactly
0:02:55 > 0:02:57how their scams work and how to spot them.
0:03:00 > 0:03:03Our policies are motor trade policies
0:03:03 > 0:03:04which provide cover for persons
0:03:04 > 0:03:06that are involved in the motor trade,
0:03:06 > 0:03:10and the cover afforded under these policies is for a number of vehicles
0:03:10 > 0:03:14rather than one vehicle which you'd see on a private car policy,
0:03:14 > 0:03:17therefore making motor trade policies attractive to somebody
0:03:17 > 0:03:20who's trying to set up a ghost broking organisation
0:03:20 > 0:03:23because they can put a number of vehicles onto those policies
0:03:23 > 0:03:26which would then all be flagged up on the motor insurers database
0:03:26 > 0:03:28and appearing as genuinely insured.
0:03:28 > 0:03:34In December 2013, Tradewise were approached by a member of the public
0:03:34 > 0:03:36who believed they were insured with the company.
0:03:36 > 0:03:40They had been experiencing some problems in obtaining documentation
0:03:40 > 0:03:42and getting hold of their broker
0:03:42 > 0:03:44and, having looked into it themselves,
0:03:44 > 0:03:46they managed to find that the vehicle was insured
0:03:46 > 0:03:49through Tradewise by looking on the motor insurers database.
0:03:49 > 0:03:54However Tradewise doesn't cater directly to members of the public.
0:03:54 > 0:03:56They decided to take a closer look to see
0:03:56 > 0:03:59if there was indeed a connection to the car.
0:04:01 > 0:04:04We identified that the vehicle in question had been placed on one of
0:04:04 > 0:04:09our motor trade policies and that's where our investigation started.
0:04:09 > 0:04:14The indicators showed that the risk had potential to be involved
0:04:14 > 0:04:16with ghost broking.
0:04:16 > 0:04:18At the same time, IFED had been alerted
0:04:18 > 0:04:20to a pattern of suspicious activity.
0:04:20 > 0:04:24A large number of individuals reported to Action Fraud that
0:04:24 > 0:04:27they'd purchased insurance for their vehicle
0:04:27 > 0:04:29through a company by the name of Personal Touch.
0:04:29 > 0:04:32Web-based Personal Touch Insurance was run by just one man
0:04:32 > 0:04:34based in Andover.
0:04:34 > 0:04:37Enquiries showed that this company did not exist.
0:04:37 > 0:04:39Once we started to look at the bank accounts,
0:04:39 > 0:04:42and also the insurance policies that had been set up
0:04:42 > 0:04:43in order to facilitate this fraud,
0:04:43 > 0:04:46it soon became apparent that there was just
0:04:46 > 0:04:48one individual that was behind all of it.
0:04:48 > 0:04:52That individual was Jaymz Clarke-Tomlinson.
0:04:52 > 0:04:55He'd set up what looked like a genuine insurance intermediary
0:04:55 > 0:04:58and through that company, he was supplying members
0:04:58 > 0:05:02of the public with certificates, cover notes, documentation
0:05:02 > 0:05:05which they would have believed had been issued by an insurance company,
0:05:05 > 0:05:09and therefore showing that they had a real insurance policy in place.
0:05:09 > 0:05:12But the vehicles appeared on the Motor Insurance Database
0:05:12 > 0:05:16in name only, and there was never any actual insurance cover.
0:05:16 > 0:05:19Clarke-Tomlinson was simply pocketing his victims' money.
0:05:21 > 0:05:24Approximately 150 victims had purchased insurance
0:05:24 > 0:05:25through Personal Touch,
0:05:25 > 0:05:28it was apparent nearly £60,000 had gone through his account
0:05:28 > 0:05:30in just over a 12-month period.
0:05:32 > 0:05:34But it wasn't just strangers who'd found his website
0:05:34 > 0:05:35that were targeted.
0:05:35 > 0:05:38He was prepared to deceive those closest to him.
0:05:39 > 0:05:42Clarke-Tomlinson would befriend a number of his victims.
0:05:42 > 0:05:45He would become friends with them,
0:05:45 > 0:05:47he would circulate in their communities.
0:05:47 > 0:05:51He was a car enthusiast, as were a number of his victims.
0:05:51 > 0:05:54One of whom was Vicky Small.
0:05:54 > 0:05:57I've got a limited-edition Subaru Impreza.
0:06:00 > 0:06:04It's number 6 of 100 Acropolis Rally limited editions...
0:06:07 > 0:06:10..that were made in 1993 in Japan.
0:06:10 > 0:06:13But as Tomlinson well knew,
0:06:13 > 0:06:17getting affordable insurance for high-performance cars isn't easy,
0:06:17 > 0:06:20which made people like Vicky more vulnerable to the scam.
0:06:20 > 0:06:25I met Jaymz Clarke-Tomlinson at Bournemouth Pride in 2013.
0:06:25 > 0:06:27After we'd done the parade and everything,
0:06:27 > 0:06:29we all came back to my house
0:06:29 > 0:06:32and it was there that he was telling,
0:06:32 > 0:06:36not just me, but everybody else, about his insurance company,
0:06:36 > 0:06:39or the company that he worked for,
0:06:39 > 0:06:42how they would beat any other quote by a minimum of 20%
0:06:42 > 0:06:44or they'll give you £100.
0:06:44 > 0:06:46Sounded like he knew what he was talking about.
0:06:46 > 0:06:48He said all the right things.
0:06:48 > 0:06:51He'd been working in insurance for a long time.
0:06:51 > 0:06:53I spoke to him about two days later
0:06:53 > 0:06:56and that was when I took out the policy.
0:06:56 > 0:06:58And it wasn't just Vicky who was caught in the fraud.
0:06:58 > 0:07:02Every one of those 150 victims thought they had purchased
0:07:02 > 0:07:06legitimate car insurance to drive their vehicles on the road.
0:07:06 > 0:07:08In fact, they were not insured at all.
0:07:08 > 0:07:12They'd had a forged certificate, they didn't have any insurance
0:07:12 > 0:07:15and therefore, not only were they putting themselves at risk,
0:07:15 > 0:07:19by driving on the road, but also other road users.
0:07:19 > 0:07:24Clarke-Tomlinson even went so far as to offer his so-called customers
0:07:24 > 0:07:26rewards for recommending others.
0:07:26 > 0:07:29I recommended not only friends in the car scene,
0:07:29 > 0:07:34in the modified car scene, I recommended family, friends,
0:07:34 > 0:07:36people that I've known for years.
0:07:36 > 0:07:39The introduction of this loyalty scheme
0:07:39 > 0:07:42showed how greedy Clarke-Tomlinson was,
0:07:42 > 0:07:44how determined and underhanded he was.
0:07:44 > 0:07:47A lot of my friends do have high-performance cars
0:07:47 > 0:07:50and they're a lot younger than me and they do struggle with insurance.
0:07:50 > 0:07:52You know, the cost of it.
0:07:52 > 0:07:54So, I thought, two birds with one stone,
0:07:54 > 0:07:57my friends are going to be getting a really good, amazing deal -
0:07:57 > 0:08:00not only prices, but a great level of cover -
0:08:00 > 0:08:03and I'm helping a new company to flourish.
0:08:03 > 0:08:06You know, I just really wanted to help everybody.
0:08:06 > 0:08:10But just six months later, Vicky's world crumbled.
0:08:11 > 0:08:15A friend of mine, messaged me and then phoned me and said
0:08:15 > 0:08:16'that his car...
0:08:16 > 0:08:19'He had a letter from the Motor Insurance Database,
0:08:19 > 0:08:20'saying his car wasn't insured.
0:08:20 > 0:08:23'He'd tried to phone the number'
0:08:23 > 0:08:26in the Manchester offices of Personal Touch Insurance
0:08:26 > 0:08:28and he couldn't get through.
0:08:28 > 0:08:31So then I tried phoning, couldn't get through,
0:08:31 > 0:08:36and it was then that a couple more people e-mailed me
0:08:36 > 0:08:39and then we realised that it was just a massive con.
0:08:39 > 0:08:41I felt absolutely sick knowing that I'd been
0:08:41 > 0:08:45driving around uninsured all that time and, unfortunately,
0:08:45 > 0:08:50I believe for some other drivers, people have had accidents,
0:08:50 > 0:08:54had points, had fines, lost their cars because they thought
0:08:54 > 0:08:56they were insured and they weren't.
0:08:56 > 0:08:58On hearing the news, Vicky moved quickly.
0:08:59 > 0:09:04The next step for me was to alert as many of my friends as possible.
0:09:04 > 0:09:08One of the worst days of my life, it was horrible.
0:09:08 > 0:09:11I had a few people come round and see me.
0:09:11 > 0:09:15There was tears, people were angry, people were shouting.
0:09:17 > 0:09:20But for Vicky, things were about to get a lot worse.
0:09:21 > 0:09:25Vicky Small had had a serious heart condition for some time.
0:09:25 > 0:09:27Clarke-Tomlinson was aware of this
0:09:27 > 0:09:31and yet, despite the fact that they'd become quite good friends
0:09:31 > 0:09:36and Vicky Small trusted him, he continued to lie and defraud her.
0:09:36 > 0:09:38The stress was horrendous
0:09:38 > 0:09:41and I ended up in hospital shortly after.
0:09:43 > 0:09:46But unbeknownst to him, the man who'd exploited Vicky
0:09:46 > 0:09:48and others was being tracked by IFED.
0:09:48 > 0:09:51Initially, he proved as elusive as his fake policies.
0:09:53 > 0:09:56We established that a number of the victims knew
0:09:56 > 0:09:59Clarke-Tomlinson by various different names.
0:09:59 > 0:10:02He seemed to frequent different addresses
0:10:02 > 0:10:05in different areas of the country and one initial report
0:10:05 > 0:10:07we had at the very beginning of the investigation,
0:10:07 > 0:10:09when he was first identified,
0:10:09 > 0:10:11suggested that he was actually working on a cruise ship.
0:10:11 > 0:10:15But before he could sail off into the sunset,
0:10:15 > 0:10:16IFED officers tracked him down.
0:10:16 > 0:10:19When IFED detectives arrested Clarke-Tomlinson,
0:10:19 > 0:10:21he was extremely upset.
0:10:21 > 0:10:23He seemed surprised that the police had managed to find him
0:10:23 > 0:10:25and he became very obstructive.
0:10:25 > 0:10:28He was a very obnoxious individual,
0:10:28 > 0:10:30so much so that, during the police interview,
0:10:30 > 0:10:31he decided that he'd had enough
0:10:31 > 0:10:34and didn't want to answer any more questions
0:10:34 > 0:10:35and that it was a waste of his time.
0:10:35 > 0:10:38So that... So he turned off the recording equipment
0:10:38 > 0:10:39halfway through the interview.
0:10:39 > 0:10:43Despite this behaviour, IFED was able to build a watertight case
0:10:43 > 0:10:46against Clarke-Tomlinson and before long,
0:10:46 > 0:10:48it was time for him to face justice.
0:10:48 > 0:10:53In May 2015, Clarke-Tomlinson appeared at Southampton Crown Court
0:10:53 > 0:10:56and he pleaded guilty to 18 counts of forgery and fraud.
0:11:00 > 0:11:01Attending court was Vicky,
0:11:01 > 0:11:05the victim who had, at one point, counted him as a friend.
0:11:05 > 0:11:09When it was time for the sentencing, because he did plead guilty,
0:11:09 > 0:11:11I felt that I needed to be there.
0:11:13 > 0:11:16Clarke-Tomlinson's £60,000 fraud
0:11:16 > 0:11:18resulted in a sentence of four years behind bars.
0:11:21 > 0:11:24No amount of money, for me, will ever undo the damage
0:11:24 > 0:11:28that's psychologically and physically been done to me.
0:11:28 > 0:11:30People like Jaymz Clarke-Tomlinson are just scum.
0:11:30 > 0:11:35They don't care who they hurt and the consequences they leave behind.
0:11:35 > 0:11:38All they want to do is get as much money as quick as possible.
0:11:38 > 0:11:41Clarke-Tomlinson was an extremely arrogant individual,
0:11:41 > 0:11:44who thought that the police wouldn't catch up with him.
0:11:44 > 0:11:48My message to any other would-be insurance fraudster
0:11:48 > 0:11:52is that you will not get away with your crime and that the police
0:11:52 > 0:11:56will catch up with you and detectives from IFED will ensure
0:11:56 > 0:12:00that you receive the most severe penalties at court for your actions.
0:12:05 > 0:12:09Later, a dodgy medical claim has a whiff of trouble.
0:12:09 > 0:12:14Our investigator also noted that the operation was listed as rhinoplasty.
0:12:14 > 0:12:17And an unconvincing tale about a mugging is dealt a blow.
0:12:27 > 0:12:30Come on down!
0:12:30 > 0:12:32The famous three words that give contestants
0:12:32 > 0:12:35on America's Price Is Right game show
0:12:35 > 0:12:37the chance to make their dreams come true
0:12:37 > 0:12:39with a big money win.
0:12:39 > 0:12:43Lucky Cathy Cashwell pumped the air as she took to the floor.
0:12:43 > 0:12:46- But would her luck continue? - On The Price Is Right!
0:12:46 > 0:12:48- Cathy.- 1,000.
0:12:48 > 0:12:511,000. And Molly?
0:12:51 > 0:12:54801, Drew.
0:12:54 > 0:12:55801!
0:12:55 > 0:12:57Actual retail price is, 1,375.
0:13:00 > 0:13:02Cathy, come on up here.
0:13:02 > 0:13:05Thinking her luck was well and truly in,
0:13:05 > 0:13:07Cathy elbowed her way onto the stage,
0:13:07 > 0:13:09barely able to contain her excitement.
0:13:09 > 0:13:11Nice to see you.
0:13:11 > 0:13:16We have a trip to Palm Springs and a trip to Santa Barbara.
0:13:16 > 0:13:19But appearing on one of the nation's biggest game shows with
0:13:19 > 0:13:22millions of viewers exposed the web of lies she'd been spinning.
0:13:22 > 0:13:24Oh, I hope you're right.
0:13:24 > 0:13:27Now she's going to try to beat 80 cents, whenever you're ready.
0:13:27 > 0:13:30In truth, Cashwell was already cashing in
0:13:30 > 0:13:34to the tune of thousands of dollars in worker's compensation.
0:13:34 > 0:13:36Some years prior to her appearance on the show,
0:13:36 > 0:13:38the former postal worker had claimed
0:13:38 > 0:13:40that a serious workplace shoulder injury
0:13:40 > 0:13:45meant that she couldn't stand, sit, kneel, squat, climb,
0:13:45 > 0:13:47bend, reach or grasp.
0:13:47 > 0:13:52As a result, she'd been collecting compensation since 2005.
0:13:52 > 0:13:54Sorry, Cathy.
0:13:54 > 0:13:57So she shouldn't have been able to do this,
0:13:57 > 0:14:00this,
0:14:00 > 0:14:01this,
0:14:01 > 0:14:03and certainly not this.
0:14:03 > 0:14:07That's right, in addition to appearing on national TV,
0:14:07 > 0:14:10Cathy Cashwell had also posted a photo on social media
0:14:10 > 0:14:13that showed her, arms high, paragliding.
0:14:13 > 0:14:17You tell me where that price goes and you're going to win both trips.
0:14:17 > 0:14:21- Santa Barbara.- Santa Barbara.
0:14:21 > 0:14:23And when I say three, flip it up - one, two, three.
0:14:23 > 0:14:25You got it.
0:14:25 > 0:14:27You're going to Santa Barbara, going to Palm Springs,
0:14:27 > 0:14:295,000 dollars worth of travel.
0:14:29 > 0:14:33But, in reality, Cathy Cashwell was going nowhere except court.
0:14:33 > 0:14:37Unsurprisingly, her ill-judged Price is Right appearance
0:14:37 > 0:14:40tipped off investigators that she was pulling a fast one.
0:14:40 > 0:14:43Evidently, she didn't think through the consequences of being
0:14:43 > 0:14:47pictured on national TV standing, reaching and grasping -
0:14:47 > 0:14:49things she claimed to be unable to do.
0:14:51 > 0:14:55On September 11th 2013, she was sentenced to three years
0:14:55 > 0:14:59of probation and was ordered to pay back the agreed amount of 30,000.
0:15:01 > 0:15:04Finally, it was time for her to shoulder the blame.
0:15:12 > 0:15:17What do you get when you combine 15 years' experience of policing,
0:15:17 > 0:15:20hostage negotiation skills and a degree in psychology?
0:15:20 > 0:15:23You get Tara Shelton from I-COG.
0:15:23 > 0:15:26Her unique background means that she can identify fraud
0:15:26 > 0:15:28more swiftly than normal.
0:15:28 > 0:15:31Our specialism predominantly surrounds something called
0:15:31 > 0:15:33conversation management.
0:15:33 > 0:15:35This comes into play when Tara and her team
0:15:35 > 0:15:38talk to claimants on the phone.
0:15:38 > 0:15:40We use very gentle techniques
0:15:40 > 0:15:43to identify fraud faster,
0:15:43 > 0:15:45but those techniques are significantly embedded
0:15:45 > 0:15:48on a cognitive and psychological basis.
0:15:48 > 0:15:51For insurance cheats, there's nowhere to hide.
0:15:51 > 0:15:53If someone is lying, we'll know.
0:15:58 > 0:16:01Often, it's the small giveaways that make Tara suspicious.
0:16:01 > 0:16:04Things that might not be obvious to you or I,
0:16:04 > 0:16:06but stand out a mile to an expert.
0:16:07 > 0:16:10In one recent case, a photographer claimed that he'd been
0:16:10 > 0:16:12the victim of a serious offence.
0:16:12 > 0:16:14He said he decided to go to the local park
0:16:14 > 0:16:18to take some moody photographs in the bad weather.
0:16:18 > 0:16:22However, when he got all of the equipment out in the park,
0:16:22 > 0:16:24in order to take the shots,
0:16:24 > 0:16:27he was approached by three youths in hoodies,
0:16:27 > 0:16:33who presented a large knife out of a pocket, threatened him.
0:16:33 > 0:16:36He then handed his equipment over, went home
0:16:36 > 0:16:38and then reported the matter to the police.
0:16:38 > 0:16:44The total value of the claim was approximately around £50,000
0:16:44 > 0:16:49and the equipment ranged from a MacBook, through to different
0:16:49 > 0:16:53types of cameras, different types of lenses.
0:16:53 > 0:16:56Erm...all of which are quite high in value.
0:16:56 > 0:16:59Not only was the claimant seriously out of pocket,
0:16:59 > 0:17:01but his livelihood was on the line, too.
0:17:01 > 0:17:05We did identify that the claimant was genuinely a paparazzi,
0:17:05 > 0:17:08quite a well-known paparazzi individual.
0:17:08 > 0:17:11Meaning that without his camera, he couldn't work,
0:17:11 > 0:17:13and therefore had no money coming in.
0:17:13 > 0:17:15As always, before making contact with a claimant,
0:17:15 > 0:17:17Tara did her homework.
0:17:17 > 0:17:20What was interesting, when we carried out some further research,
0:17:20 > 0:17:24is he had changed his name on three occasions previously,
0:17:24 > 0:17:29was being, again, chased by debt collectors
0:17:29 > 0:17:33and was now, as a grown man, living with his mother.
0:17:33 > 0:17:38It was time for Tara to get a fuller picture of the case.
0:17:44 > 0:17:48I found the claimant quite a fascinating character
0:17:48 > 0:17:54because he described a knife-point robbery in the most vaguest...
0:17:56 > 0:18:00..shortest, non-emotional detail I think I've probably ever heard.
0:18:22 > 0:18:25If someone has genuinely been held up at knife-point,
0:18:25 > 0:18:28it should be either quite a traumatic incident,
0:18:28 > 0:18:33or certainly an incident where you can provide some detail.
0:18:33 > 0:18:35But there was.... There was nothing like that at all.
0:19:02 > 0:19:06If he couldn't believe it, how did he expect others to?
0:19:06 > 0:19:10At this point, the conversation started to get even more surreal.
0:19:10 > 0:19:14And on top of this, he still remained very, kind of,
0:19:14 > 0:19:19non-emotional but, he was also making really inappropriate jokes.
0:19:19 > 0:19:23which I found quite bizarre,
0:19:23 > 0:19:25considering you're talking about a knife-point robbery.
0:19:45 > 0:19:46Would you Adam and Eve it?
0:19:46 > 0:19:50At this stage, he probably wanted to put down the dog and bone.
0:19:50 > 0:19:51But Tara wasn't done yet.
0:20:05 > 0:20:07But hitting the hard stuff wasn't going to help,
0:20:07 > 0:20:11and in reality, the photographer had shot himself in the foot.
0:20:11 > 0:20:14Tara could see right through the snapper's flimsy story.
0:20:14 > 0:20:19People scrabble to spontaneously lie
0:20:19 > 0:20:23and when they are in a position
0:20:23 > 0:20:25where they have to spontaneously lie,
0:20:25 > 0:20:29what happens is the brain goes into a meltdown.
0:20:29 > 0:20:33The cracks were just getting more and more and more obvious to me.
0:20:52 > 0:20:54Sorry to keep you, mate!
0:20:54 > 0:20:57For Tara, there was one moment where the photographer's account
0:20:57 > 0:21:00really started to lose all focus.
0:21:00 > 0:21:04The main game changer was actually my natural response
0:21:04 > 0:21:06to something that he said to me,
0:21:06 > 0:21:12which was that he walked home quite calmly after this had happened.
0:21:12 > 0:21:15Even though there was a landline available in the home,
0:21:15 > 0:21:20he decided not to call 999 there, and to walk to the police station.
0:21:20 > 0:21:23And then I asked how far the police station was away.
0:21:23 > 0:21:26According to the claimant, it was just down the road.
0:21:39 > 0:21:41That is one heck of a long road,
0:21:41 > 0:21:44but, unfortunately for him, it finished in a dead end.
0:22:01 > 0:22:02"Yeah, OK?"
0:22:02 > 0:22:04Surely a genuine claimant
0:22:04 > 0:22:06would be protesting their innocence at this point.
0:22:06 > 0:22:08Tara had heard enough.
0:22:40 > 0:22:42Finally, the photo journalist
0:22:42 > 0:22:44accepted that his story had been spiked.
0:22:44 > 0:22:47He completely underestimated the level of detail
0:22:47 > 0:22:51that is required and, ultimately, he failed at the first hurdle.
0:22:51 > 0:22:54But there was a way to pick himself back up.
0:22:54 > 0:22:57Tara had already agreed a strategy with the insurance company.
0:22:57 > 0:23:01When I outlined that one of the options that the insurer was willing
0:23:01 > 0:23:04to accept a withdrawal of the claim,
0:23:04 > 0:23:08he was quite happy to withdraw the claim.
0:23:08 > 0:23:11Thanked me for my time and for my professionalism.
0:23:11 > 0:23:14Clearly, he realised that he'd more than met his match.
0:23:21 > 0:23:24The news man had been well and truly scooped.
0:23:32 > 0:23:34Holidays should be spent on the beach,
0:23:34 > 0:23:37not in a hospital emergency department.
0:23:37 > 0:23:40But that's where one unfortunate traveller ended up.
0:23:42 > 0:23:44CEGA, a company that provides global travel
0:23:44 > 0:23:48and medical claims services processed the paperwork.
0:23:50 > 0:23:53Simon Cook is their head of special investigations.
0:23:53 > 0:23:57The customer told us that while she was on holiday in Lebanon,
0:23:57 > 0:24:01due to an accident, she had to have an emergency operation to her nose.
0:24:01 > 0:24:04And that she wanted to claim for the cost on her travel insurance.
0:24:04 > 0:24:08The value of the claim was approximately £2,000.
0:24:08 > 0:24:11Covering medical costs abroad is all part of the package
0:24:11 > 0:24:13that CEGA provides.
0:24:13 > 0:24:15On the face of it, we had no reason to doubt that this was
0:24:15 > 0:24:16a valid claim.
0:24:16 > 0:24:19And it was only when they began to sniff around
0:24:19 > 0:24:20that there were concerns.
0:24:20 > 0:24:24It is a condition of this particular insurance policy that you contact
0:24:24 > 0:24:28the emergency medical helpline if you require an operation,
0:24:28 > 0:24:31so that we can ensure that you're getting the right treatment.
0:24:31 > 0:24:34But there had never been any communication from the claimant.
0:24:34 > 0:24:36Most genuine customers want to contact
0:24:36 > 0:24:38our medical emergency helpline,
0:24:38 > 0:24:40because it is quite a daunting experience
0:24:40 > 0:24:42being in hospital overseas.
0:24:43 > 0:24:45And there was one thing in particular
0:24:45 > 0:24:48which made them sniff danger.
0:24:48 > 0:24:51Our medical expert explained that there were no x-rays
0:24:51 > 0:24:54or any other tests carried out so they were unsure
0:24:54 > 0:24:58how they could determine whether an operation was required.
0:24:58 > 0:25:00The lack of assessments of her injuries clearly
0:25:00 > 0:25:02went against normal medical practice.
0:25:02 > 0:25:04To perform an operation such as this
0:25:04 > 0:25:08without first conducting x-rays or some form of test
0:25:08 > 0:25:10goes against normal medical practice.
0:25:10 > 0:25:13Due to the concerns we had with the claim,
0:25:13 > 0:25:16we decided to conduct a telephone interview with the customer.
0:25:18 > 0:25:21CEGA's investigator sensed that there was something
0:25:21 > 0:25:24iffy about the nose injury story itself.
0:25:24 > 0:25:25The customer told us that she
0:25:25 > 0:25:29had been chasing her daughter around her sister's flat.
0:25:33 > 0:25:37Unfortunately, she ran straight into a glass door.
0:25:37 > 0:25:41The first question that sprung to mind for our investigator was
0:25:41 > 0:25:43well, "What happened to your daughter?"
0:25:43 > 0:25:47Surely, if the customer was chasing after her daughter round the flat,
0:25:47 > 0:25:50then her daughter must have hit the glass door first.
0:25:50 > 0:25:53At this point, there was a long awkward silence,
0:25:53 > 0:25:57and we had to actually check whether the customer was still on the line.
0:25:57 > 0:25:59The customer broke her silence and she told us
0:25:59 > 0:26:02that she'd got the circumstances incorrect.
0:26:05 > 0:26:08She was, in fact, being chased by her daughter
0:26:08 > 0:26:11as opposed to her chasing her daughter.
0:26:13 > 0:26:14The story was starting to reek
0:26:14 > 0:26:18and the investigator decided to nose around the doctor,
0:26:18 > 0:26:20who was genuine enough.
0:26:20 > 0:26:22However, the doctor did not specialise
0:26:22 > 0:26:24in emergency medical treatment.
0:26:24 > 0:26:26CEGA then took the radical step
0:26:26 > 0:26:29of appointing an overseas investigator
0:26:29 > 0:26:31to pay the doctor a visit in person.
0:26:31 > 0:26:34Our investigator made an appointment at the hospital
0:26:34 > 0:26:38to speak with the doctor and when our investigator arrived,
0:26:38 > 0:26:41the doctor was well aware that we were going to be visiting.
0:26:41 > 0:26:43Without even referring to any paperwork,
0:26:43 > 0:26:46the doctor actually validated the claim
0:26:46 > 0:26:48and said that our customer had received
0:26:48 > 0:26:51an emergency medical operation.
0:26:51 > 0:26:53The doctor actually told us
0:26:53 > 0:26:57that he had nothing further to add to the situation and left.
0:26:57 > 0:27:00Undeterred, the investigator spoke to the hospital receptionist
0:27:00 > 0:27:04and it was at this point that things started to get interesting.
0:27:04 > 0:27:08She then decided to bring up the official computer records
0:27:08 > 0:27:10in front of our investigator.
0:27:10 > 0:27:12Our investigator also noted that that the operation was
0:27:12 > 0:27:14listed as rhinoplasty.
0:27:14 > 0:27:17This is more commonly known as a nose job.
0:27:17 > 0:27:20A cosmetic procedure, definitely not something associated with
0:27:20 > 0:27:22a medical emergency.
0:27:22 > 0:27:24Given the significant inconsistencies
0:27:24 > 0:27:27with the circumstances the customer provided us with,
0:27:27 > 0:27:29we were satisfied that the incident
0:27:29 > 0:27:32involving her running into a glass door did not happen.
0:27:32 > 0:27:36They saw right through the story to the likely explanation.
0:27:36 > 0:27:39As far as we were concerned, this was a case of medical tourism
0:27:39 > 0:27:42and the customer had travelled to Lebanon
0:27:42 > 0:27:46with the intention of having a nose job whilst on holiday.
0:27:46 > 0:27:48Needless to say, travel insurance doesn't cover
0:27:48 > 0:27:52this type of plastic surgery and the claim was declined.
0:27:53 > 0:27:56The customer initially tried to contest our decision,
0:27:56 > 0:27:58but after we wrote back to her,
0:27:58 > 0:28:01she decided not to pursue the claim any further.
0:28:01 > 0:28:03Shown that she knows what's good for her,
0:28:03 > 0:28:04the woman finally walked away.
0:28:04 > 0:28:08This investigation just proves that we take a hard-nosed approach
0:28:08 > 0:28:09to investigating fraud.