Large-Scale Insurance Fraud Investigations of saving fraud claims loss of USD $2,898,795.18

Subject: Commissioned by a global insurance firm on the authenticity of transactions cited in invoices provided by claimants.

By: Premier Consultancy Investigations 

Overview

Premier Consultancy & Investigation Private Limited conducted a nationwide investigation into suspicious insurance claims to verify the authenticity of businesses and transactions cited on invoices. Commissioned by a global insurance firm, the investigation aimed to identify and mitigate fraudulent practices within the claims process.

Objective

To validate the existence of businesses and the authenticity of transactions cited in invoices provided by claimants.

Key Investigation Highlights

• Scope: Multiple districts across India 
• Approach: A combination of telephone verifications, desktop research, social media analysis, and physical site visits.
• Outcome: Of the nine invoices investigated, eight were identified as fraudulent due to either non-existent businesses or discrepancies in the invoice details.

Findings

1. Non-Existent Businesses:
   • Shops were never present nor located at the given addresses.
   • Telephone inquiries and local shopkeeper feedback confirmed their non-existence.
2. Fraudulent Invoices for Existing Shops:
   • Shops that were verified to exist, the invoices submitted for claims were declared fraudulent by the shop owners.
3. Verified Authenticity:
   • Only one of the invoice from a known branded store in India was confirmed as genuine yet having fake invoices

Methodology

The investigation employed a multi-faceted methodology:

• OSINT and Desktop Research: Use of digital tools and business directories to cross-verify shop details.
• Social Media Analysis: Review of platforms like Instagram and Facebook for operational insights.
• Physical Inspections: Visits to the mentioned locations to confirm the existence and operations of shops.
• Evidence Collection: Documentation through photos, videos, and testimonies.

Breakthrough Investigations

• Discrepancies in the invoice details, including mismatched addresses and phone numbers. The shop owner confirmed the invoices were fraudulent
• Identified a similarly named business, but shop owners denied issuing the disputed invoices.

Value delivered

The investigation revealed a systematic attempt to manipulate insurance claims by submitting fraudulent invoices, which saved fraudulent transactions, which led to total estimated potential loss of approximately USD $2,898,795.18 These findings provided the insurance company with actionable evidence to reject fraudulent claims and refine their processes for future verifications.