Insurance commissioner warns of fraud, scams during visit to Rockingham

ROCKINGHAM — Every type of insurance has associated scams, Insurance Commissioner Mike Causey told the small crowd gathered Thursday at Leath Memorial Library.

“But the biggest fraud out there today is in healthcare,” Causey continued.

Nearly half of the submitted Medicaid and Medicare claims are fraudulent, according to the commissioner.

“We used to say one out of 10 is a fraudulent claim,” Causey said regarding all insurance claims. “It’s way higher than that.

“Actually, proven fraud on an insurance claim is not that difficult, because all you have to do … is just show that somebody made a false statement in order to get a higher reimbursement. And this happens a lot.”

Causey gave a hypothetical example of someone claiming chainsaw stolen during a break-in — “bought at a yard sale for 25 bucks” — as having been bought for $400.

“Some folks get away with it, but we’re pinching folks every day,” Causey said, “and its a felony.”

The commissioner said the N.C. Department of Insurance is trying to educate the public to be “be alert” for fraud.

The town hall meeting in Rockingham was the second on fraud this year.

“If somebody’s coming to your door, if they’re trying to sell you anything, you need to be real suspicious because …most of the time it’s a scam,” Causey said. “There are a lot of people that are scam artists that are trying to cheat people.”

Causey said there were even scammers with business cards purporting that they work for DOI and were trying to sell insurance policies. However, he added, the department doesn’t sell policies.

DOI has the oldest fraud investigation unit in the nation, according to the department’s website.

So far this year, DOI has made 215 fraud-related arrests and has had 99 convictions, resulting in $3.79 million in restitution and recoveries, the website states.

Within the past three months, two women in neighboring Moore County and one in Anson County have been among those charged with insurance fraud.

Causey also warned of door-to-door construction scammers, especially after wind or hail storms.

“All they’re looking for is to get a little money and as soon as they get the money, they’re probably gone and you’re not going to get the work done,” the commissioner said. “I don’t know what it is about Southeastern North Carolina, but there sure is a lot of fraud in these counties.”

Brian Gibson, of the DOI’s Criminal Investigations Division, said roofing scams are the most prevalent.

Gibson gave examples of scammers actually climbing up onto roofs without permission.

“If you want to impact someone, you hit them financially,” Gibson said, comparing fraud to other types of crimes he’s investigated during his law enforcement career. “They can feel that for a long time.”

(Note: Despite the meeting being free and open to the public, Gibson said recording of his presentation was “not allowed.”)

Detective Steve Odom with the Rockingham Police Department said most of the fraud cases dealt with locally involve credit and debit card theft.

Odom also warned of phone and social media scams, especially those targeting the elderly. He said there have cases where grandparents have sent thousands of dollars thinking they were helping a grandchild in trouble.

The Richmond County Sheriff’s Office has reported several phone scams over the past several years involving the caller claiming to be a deputy telling the would-be victim that a fine is owed for missing jury duty.

Several in the audience mentioned receiving potential phone scam calls on a daily basis. One even said she received a call using her mother’s voice.

Gibson told the audience not to verify information over the phone for an unsolicited call, even if you think the call could be legitimate.

The best thing to do if you suspect a scam, Gibson said, is hang up or not even answer the phone.