Insurance Fraud Crackdown: 50 Rings Dismantled
In recent years, the phenomenon of insurance fraud has become more organized, professional, and trans-regional, involving multiple institutions, and such cases are on the rise. Combating insurance fraud and purifying the insurance market environment is becoming an essential part of social governance.
Recently, the Economic Crime Investigation Bureau of the Ministry of Public Security, in conjunction with the Inspection Bureau of the State Financial Regulatory Administration (hereinafter referred to as "Financial Regulatory Administration"), held a national on-site promotion meeting for the special crackdown on insurance fraud crimes. The meeting emphasized the need to strengthen overall planning and coordinated promotion, to wage a tough battle, and to launch a fierce offensive against a batch of major cases, severely cracking down on prominent insurance fraud crimes.
According to official disclosures, since the Economic Crime Investigation Bureau of the Ministry of Public Security and the Inspection Bureau of the Financial Regulatory Administration launched a special crackdown on insurance fraud crimes in April this year, the public security economic investigation departments have filed investigations into more than 150 major insurance fraud crime cases, dismantled nearly 50 insurance fraud criminal gangs, and the amount involved in the cases is nearly 500 million yuan.
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The reporter noted that in August this year, the Financial Regulatory Administration issued the "Anti-Insurance Fraud Work Measures" (hereinafter referred to as the "Measures"), which clearly established a four-in-one working system of "regulatory guidance, institution-based, industry joint prevention, and joint efforts from all parties". It压实ed the main responsibility of insurance institutions, organized and carried out big data anti-fraud work, and established and improved the collaboration mechanisms with public security organs, market supervision, judicial administration, and other departments.
Many experts have told the reporter that insurance fraud can bring many adverse effects. Preventing insurance fraud requires the joint efforts of insurance companies, consumers, regulatory authorities, and all sectors of society to form a joint force in order to effectively curb the occurrence of insurance fraud.
Fraud methods are more covert
Insurance fraud refers to the act of seeking illegal benefits by using insurance contracts, which mainly includes obtaining insurance money by deliberately fabricating insurance subjects, fabricating insurance accidents that have not occurred, fabricating false causes of accidents or exaggerating the extent of losses, and intentionally causing insurance accidents.
In our country, insurance fraud not only occurs in traditional insurance types such as vehicle insurance, disease and medical insurance, and personal accidental injury insurance but also concentrates in public insurance types such as agricultural insurance and major disease insurance.
It should be noted that many cases have shown that insurance fraud has shown some new characteristics. Professional and group crimes are more obvious, and the methods of implementation are more covert and diversified.
For example, some insurance fraud perpetrators are highly familiar with the management methods and operation processes of insurance companies. They are not only very familiar with the underwriting and claims processes of corresponding insurance businesses but also have a deep understanding of the development of insurance products and the types of risks underwritten, making the fabricated insurance accidents highly deceptive and covert.Recently, according to the disclosure by Le Gang, the head of the Financial Crime Investigation Department of the Economic Crime Investigation Bureau of the Ministry of Public Security, since 2020, some insurance company intermediaries have taken advantage of their familiarity with the compensation process of employer's liability insurance. They have colluded with some high-risk job enterprises (employers) to use methods such as cross-provincial insurance, work injury insurance, and multiple insurances for employer's liability insurance. They have used fabricated work injury accidents and forged related documents and materials to apply for claims from insurance companies. In the claims process, they have used methods such as repeated claims for the same insurance accident, signing dual contracts, and controlling the injured person's bank card to intercept compensation funds to defraud employer's liability insurance compensation funds, totaling more than 40 million yuan in insurance claims.
An insider from a property insurance company revealed to the reporter that some highly specialized insurance fraud gangs have clear internal division of labor and organized management, which has greatly exceeded the insurance industry in terms of identifying and preventing insurance fraud. For example, short message services are one of the common ways for insurance companies to provide preferential services, business confirmation, and information notification. However, some criminals have used the name of insurance companies to send fraudulent messages to consumers, which is confusing.
The reporter learned from ZhongAn Online Property Insurance Co., Ltd. (hereinafter referred to as "ZhongAn Insurance") that a few months ago, ZhongAn Insurance received customer feedback that they had received fraudulent messages sent in the name of ZhongAn Insurance. In response to this incident, the company immediately established a special investigation team and reported the situation to the local police station for the first time.
It is understood that ZhongAn Insurance established an investigation team to collect evidence through field visits. Within a week after the incident, the investigation team went to four provinces and six cities to investigate and visit five levels and seven companies on the chain of fraudulent message sending, forming a solid and sufficient chain of evidence.
"Finally, it was confirmed that the batch of fraudulent messages was sent by some personnel of a company in Sichuan in the name of ZhongAn Insurance, and all the materials involved were forged. On the basis of having sufficient evidence, we immediately reported to the Shanghai Public Security Bureau and reported the situation to the Shanghai Anti-Fraud Center. Now the case has been solved, and the criminal suspects have been arrested." The person in charge of ZhongAn Insurance further stated to the reporter.
Fraud by forging "Insurance Company"
In addition to sending messages in the name of insurance companies for insurance fraud, recently, the illegal acts of some lawbreakers who defraud by setting up fake insurance companies have also been exposed by supervision.
On August 14, the Hainan Supervision Bureau of the Financial Supervision Administration (hereinafter referred to as "Hainan Supervision Bureau") issued a "Risk Warning on the Operation of Financial Business without a Bank Insurance Institution License", stating: "Recently, our bureau, in conjunction with the Hainan Provincial Market Supervision Administration, found that Hainan Coconut Financial Consulting Co., Ltd. changed its company name to 'Hainan Yuanbang Property Insurance Co., Ltd.' on December 15, 2023, and started business activities." "Hainan Yuanbang Property Insurance Co., Ltd." was established without the approval of the national financial regulatory authorities, and illegally carried out business activities without obtaining the qualifications for insurance business, insurance brokerage business, and other financial business operations. Consumers are advised not to be deceived.
At the same time, the Hainan Provincial Market Supervision Administration has processed "Hainan Yuanbang Property Insurance Co., Ltd." in the National Enterprise Credit Information Publicity System with its unified social credit code (91460000MA5TURRR20) instead of its company name, and made a risk warning "No insurance license, not allowed to engage in insurance business activities."
This is the second fake insurance company discovered and warned by the Hainan Supervision Bureau. On July 26 this year, the Hainan Supervision Bureau disclosed that a company named "Hainan Dachang Property Insurance Co., Ltd." was illegally operating insurance business or engaging in insurance fraud activities in some parts of the country. Soon after, the Shanxi Supervision Bureau of the Financial Supervision Administration also issued the same risk warning.On August 12th, the Guizhou Regulatory Bureau of the Financial Regulatory Administration issued a "Notice on Identifying Insurance Intermediary Business Qualifications," highlighting that consumers should promptly report to local financial regulatory authorities if they discover institutions without insurance intermediary business qualifications engaging in such activities in violation of regulations.
Gao Zelong, Secretary-General of the China Internet Integrity Promotion Alliance, told reporters that consumers should carefully choose legitimate insurance companies or legally authorized agencies when purchasing insurance products, and be vigilant against illegal institutions or individuals' schemes and traps. When encountering calls or similar situations claiming to be from insurance company personnel, if there is any doubt, one can promptly verify the authenticity and qualifications of the relevant personnel through the company's website, unified customer service phone numbers, and other channels to avoid being deceived.
Strengthening Mechanism Coordination and Technological Innovation
The increasingly diverse and complex fraudulent methods undoubtedly pose a severe challenge to the insurance industry.
It is reported that to maintain market order and promote high-quality development of the insurance industry, from the end of April to the end of November 2024, the Economic Crime Investigation Bureau of the Ministry of Public Security, in conjunction with the Inspection Bureau of the Financial Regulatory Administration, jointly carried out a 7-month special crackdown on insurance fraud crimes.
According to the deployment, financial regulatory authorities at all levels have organized industry forces to focus on tackling insurance fraud risks in prominent types of insurance and channels; they have promoted the empowerment of big data for anti-fraud work, deeply excavated clues, and promptly transferred them to public security organs; they have strengthened source governance, improved the quality and efficiency of law enforcement and judicial work in the financial field, and truly optimized the business environment in the insurance field, providing protection for high-quality financial development.
It should be noted that since the launch of the special action, there have been phased work results in anti-insurance fraud.
According to the Ministry of Public Security, since the launch of the special crackdown, public security organs and financial regulatory authorities have improved the working mechanism for the connection between administrative and criminal penalties. In cooperation with industry associations and insurance institutions, they have conducted precise analysis, focused on tackling, and made breakthroughs in key categories against insurance fraud behaviors such as employer's liability insurance fraud with abnormally high compensation rates, "porcelain-plying" fraud that directly infringes on the life, health, and property rights and interests of the people, fraud against specific fiscal subsidy insurance types that endanger public financial funds, and professional fraud targeting loopholes in new types of insurance and new products. The special crackdown has achieved phased results.
To prevent and resolve insurance fraud risks and enhance the comprehensive risk management capabilities of the insurance industry, in terms of top-level design, the regulatory authorities have issued the "Regulations," which clarify the anti-fraud responsibilities and tasks of insurance institutions, and standardize organizational structure, internal control, risk identification and handling, information systems and data management, and publicity and education.
At the same time, the "Regulations" have added requirements for insurance institutions to regularly conduct evaluations of the fraud risk management system and report to regulatory authorities; added special requirements for the management of policy-based insurance fraud risks; and added strengthened requirements for risk information verification at the underwriting and claims ends, requiring an improvement in the quality and efficiency of claims handling, and prohibiting delays in claims processing or unreasonable denial of claims. In terms of industry collaboration in anti-fraud, the "Regulations" have clarified the division of anti-fraud responsibilities among relevant industry organizations and standardized the basic process of big data anti-fraud and the responsibilities of each participating entity."Insurance companies such as Silver Insurance and Trust should fully leverage the centralized management advantages of big data platforms under the guidance of the Financial Regulatory Authority and its dispatched institutions. They should explore the establishment of industry anti-fraud information platforms and anti-fraud intelligence centers for multiple insurance types, monitor and analyze industry fraud risks, conduct centralized screening of suspicious fraud data, and refer discovered fraud leads to local insurance industry associations and anti-fraud organizations, insurance institutions for verification. In cases of suspected crimes, promptly report to the public security authorities." The "Regulations" indicate.
Interviews with journalists have revealed that regulatory authorities, in conjunction with the Ministry of Public Security, have launched pilot programs for big data anti-insurance fraud in various locations. They have innovated in using new technologies such as big data to prevent insurance fraud risks and combat financial crimes. They have also developed data models for fraud crimes in various insurance types, including auto insurance, accidental injury insurance, and flight delay insurance. These models are used for intelligent analysis and judgment of case leads, thereby increasing the precision of combating financial fraud crimes.