Insurance Fraud

Investigations Division

The mission of the Insurance Fraud Unit is to deter, investigate and facilitate conviction of fraud perpetrated against an insurance company or any other Arizona-licensed insurance entity (a.k.a. "insurance fraud").

The mission of the Administrative Enforcement Section ("AES") is to investigate allegations of theft and other wrong-doing by licensed insurance professionals, including agents/producers, adjusters and bail bond agents, and insurance scams perpetrated by unlicensed individual and enterprises. The AES, in part, investigates fraud perpetrated against insurance consumers (a.k.a. "consumer fraud").

Insurance Fraud Information

Insurance fraud occurs when individuals deceive an insurance company, agent or other person to try to obtain money to which they are not entitled. It happens when someone puts false information on an insurance application and when false or misleading information is given or important information is omitted in an insurance transaction or claim.

Insurance fraud is committed by individuals from all walks of life. Efforts of the Insurance Fraud Unit have resulted in convictions of doctors, lawyers, chiropractors, car salesmen, insurance agents and others who have committed fraud.

Insurance fraud can be "hard" or "soft."

Hard Fraud: Someone deliberately fakes an accident, injury, theft, arson or other loss to collect money illegally from insurance companies. Crooks often act alone, but increasingly, organized crime rings stage large schemes that steal millions of dollars.
Soft Fraud: Normally honest people often tell so-called "little white lies" to their insurance company. Many people think it's just harmless fudging. But soft fraud is a crime, and raises everyone's insurance costs.

Reporting Insurance Fraud

Type of fraud issue	How to report fraud
To report fraud against insurance companies (including but not limited to cases involving insurance-related identity theft, telemarketing and spam)	Use our Fraud Referral Form
To report Health Insurance Marketplace consumer fraud	Call the Health Insurance Marketplace at 1-800-318-2596
To report fraud or scams against an insurance consumer (individual or business)	File a complaint with the Department of Insurance
To report identity theft; unwanted telemarketing, texts, or spam; and, various other types of business practices that are unfair to consumers	File a complaint with the Federal Trade Commission (FTC) File a complaint with the Arizona Attorney General's Office

Consumer Fraud

Protect Yourself Against Scams!

The best protection is prevention! You wouldn’t choose a nursing home or hire a builder without doing some homework…the same applies to insurance!

Fake insurance comes in all types: health, boat, medical malpractice, surety, business and professional liability, long term care. It is marketed to all types of people and businesses. Verify before you buy!

Read information about health insurance marketplace scams from the US Department of Health and Human Services.
Read information about health insurance scammers from the National Association of Insurance Commissioners.
Make sure the insurance company and agent ("insurance producer") are licensed in Arizona by finding their information on our License Search web page. Check the exact name being used. Scammers often use names that are similar to those of legitimate insurance businesses.
Research the insurer: Contact the Better Business Bureau; use links on our License Search web page to get financial ratings from AM Best and other financial rating services; ask the Department of Insurance for complaint figures and financial information.
Check out websites. Can you find a physical address? names of company officers? valid phone numbers? a way for you to contact the company besides email? Don’t settle for a P.O. Box, voice mail or email.
Don’t let slick looking websites, business cards, “official” forms, and marketing materials persuade you that an insurance entity is legitimate.
Review documentation carefully—make sure it looks “original”, not photocopied; look for a seal and authentic signatures.
If the paperwork looks suspicious (or even if it doesn't), contact the insurance company listed to verify that a policy was issued and call the Department of Insurance to verify licensure.
Ask questions, keep notes about who you spoke to and when, keep copies of documents, and always pay with a check or credit card.
Research “Discount” health plans and cards carefully. They are not insurance and typically not government regulated. “Discount” plans have been the subject of many nationwide fraud allegations.

Warning Signs

You might be vulnerable to an insurance scam if...

You get a quote that is substantially lower than ones you previously received.
You receive an unsolicited offer, quote or advertisement.
You are told the advertised price “expires” or is for a “limited time only.”
No physical address, phone numbers, or names of company officers appear on website or literature.
The alleged insurer’s name is similar to that of another well-known insurance company.
You’re told “This insurance is not regulated by the State" or “This is not insurance," but it sounds like insurance.

Contacts for Avoiding/Reporting a Scam

Health Insurance Marketplace Consumer Fraud: (800) 318-2596
Federal Trade Commission Complaint: http://www.ftc.gov/ftc/contact.shtm
Arizona Attorney General Consumer Protection Office:
Web: https://www.azag.gov/consumer
Phone: (602) 542-5763 or
(800) 352-8431 within Arizona but outside the Phoenix area.
Insurance Consumer Question/Complaint:
Web: https://insurance.az.gov/consumers
Email: [email protected]
Phone: (602) 364-2499 or (800) 325-2548 within Arizona but outside the Phoenix area.

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Warning Signs

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Insurance Fraud Unit

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