Employee frauds are very common in any kind of company. Whether you are a small business or a larger one, there are always a handful of troublemakers who tend to take advantage of your company’s policies and cheat you. Yes, controlling them is very essential to ensure that your company moves on smoothly. But most of the time due to the flexible policies and the terms and conditions attached to them, these workers get out very conveniently. And the most common liability is that you have to pay a hefty sum as insurance claims to the workers.
Beware of these common signs that point towards an employee’s fraud!
The best way to prevent such kinds of fraud is to hire a private investigator from Oracle who will inquire about this matter in depth for you and even bring out valid proofs to support your theory against the employee who is cheating you. But if you are still hesitant to take this step and want to watch out for the fraud for yourself, then consider the below listed red flags:
o Plentiful history of past claims — When the concerned employee has a rich record of past claims with other employers as well, then most probably this person knows the tactics to get away with such claims. So, definitely this one is even framing a false claim on you. Be sure to check the previous history thoroughly of the employee claiming the sum from you.
o No witnesses — When the claimant says that he/she was injured or ill and has no witnesses to support the claim, then there is something very suspicious here. Most of the time your insurance claims investigator tends to inquire deeper into the matter and get you the information. But if there are no witnesses, then there’s probably something fishy going on here.
o Conflicting discrimination— The clear proof of a fraud by an employee is conflicting discrimination. When you ask the employee about the incident or the treatment that he or she went through, the answer of the claimant would vary from time to time. And this is something that says that there is a fraud going on here.
o Refusal on treatment — If the employee who is claiming to be ill or to have faced an accident (and wants insurance for the same) provides multiple excuses when you ask the person to go for a treatment, then there’s definitely something fishy. Most of the time, the person who has recently been through an accident or is combatting an illness won’t hesitate to go for treatment or a check-up to verify his or her point. If the person is hesitant, then there’s something wrong here.
o Late reporting of the case — Normally a person who wants an insurance claim would report the injury issue or the medical problem within a week or two. But if the employee has reported the problem really late (say, a delay of more than a month), then it may be a fraud case and you have to enquire in depth about the issue.
o Same medical institution reporting the issue — If your employee has filed an insurance claim and provides you with medical results, be sure to compare it with the previous cases of the employee or even other employees. If you see the name of the medical institution repeating in more than two different cases or more than once in the same person’s case, then this is something to be doubtful about.
o Claimant is hard to reach — When the employee has already claimed the insurance and if you are trying to reach the person when he or she should be at home resting or under medical treatment, but you couldn’t reach that person, then it’s a red flag situation.
These are the red flags that you have to first look for when your employee claims medical insurance. And when you find even one doubtful sign, then it is better that you appoint a private investigator to look into this matter in detail. Because it’s always better to prevent the fraud and not oblige to the claim rather than accepting the same leniently and provide encouragement to this kind of behaviour for future.