Staged Accidents

Staged accident fraud is a sort of insurance fraud in which one or more people stage an accident in order to file an insurance claim. This form of fraud is generally committed by a group of people who simulate an accident and then file false insurance claims for fictitious injuries and vehicle damage.

If you come across or suspect such fraudulent acts, please do not hesitate to report them to us via the methods listed on this page.

Exaggerated claims fraud

Exaggerated claims fraud is a sort of insurance fraud in which a policyholder inflates the value of a genuine insurance claim in order to gain a larger settlement from their insurance provider. This form of fraud can happen with any type of insurance, including home/domestic, industrial, auto, or medical.

Exaggerated claims fraud can have major financial ramifications for us since it increases expenses, which are then passed on to other policyholders in the form of higher premiums. As Goldstar, we frequently analyze questionable claims in order to discover cases of exaggerated claims fraud and may take legal action against people who engage in this criminal behavior.

Fictitious Insurance claims

Premium Embezzlement fraud

Insurance premium embezzlement happens when an insurance agent or broker takes premiums from clients but fails to pay a portion or the entire amount to the insurance company. Instead, the money is kept by the agent or broker for personal advantage.

Premium embezzlement fraud may occur in any form of insurance, including auto insurance, home insurance, and life insurance. It can have major ramifications for policyholders, who may assume they have coverage when they do not. If a claim is submitted after the insurance has lapsed owing to non-payment of premiums, the policyholder may not get the intended benefits.

Policyholders can defend themselves against premium embezzlement fraud by maintaining precise records of their insurance payments and checking that their payments have been received and credited to their accounts. They can also contact the insurance company to confirm that their policies are still in existence and that all premiums have been paid.

Individuals can also do background checks on insurance agents and brokers before doing business with them, and report any suspected fraud to the insurance company or law enforcement authorities.

Identity theft Fraud

Identity theft fraud in insurance happens when someone illegally obtains insurance coverage or makes false claims on an existing insurance policy using stolen personal information. Without the victim’s knowledge or approval, the fraudster may use the victim’s name, National ID card number, KRA PIN number, phone number, date of birth, and other personal data to apply for and/or claim for insurance plans such as health, life, or auto insurance.

After obtaining the policy, the fraudster may make fake claims or inflate actual claims in order to collect money from the insurance company.

Individuals can protect themselves by using strong passwords, not sharing sensitive information with others, reporting the loss of personal documents such as ID to law enforcement and Goldstar, and monitoring their account statements for suspicious activity. They should also go over their insurance plans on a regular basis to ensure that all coverage and claims are valid.

Medical Insurance Fraud

Medical insurance fraud occurs when an individual deliberately provides false or deceptive information to an insurance company with the intention of obtaining payments or benefits that they are not legitimately entitled to. This deceitful behavior encompasses a broad range of actions, such as submitting invoices for services that were never actually rendered, exaggerating the gravity of a medical condition or injury, or prescribing treatments or medications that are unnecessary.

Engaging in medical insurance fraud carries significant consequences for both the insurance provider and the patient involved. It contributes to the escalation of healthcare costs for everyone and has the potential to adversely affect patients by exposing them to unnecessary or unsuitable medical interventions. Additionally, individuals found guilty of fraudulent activities can face legal repercussions, including fines and imprisonment.

Patients have the ability to safeguard themselves by diligently examining their medical invoices, seeking clarification regarding any unfamiliar charges, and promptly notifying the insurance company about any suspected fraudulent activities.

Healthcare providers also have a part to play in thwarting fraud by ensuring precise billing practices limited to medically essential services. They can establish protocols and systems to identify and prevent fraudulent activities, such as implementing pre-authorization requirements for specific treatments or medications, implementing strong patient identification measures, and conducting regular assessments of billing procedures.

Cyber/Digital Fraud

In the digital era we live in, there is a growing concern regarding cyber fraud. Cyber fraud encompasses deceitful activities carried out using electronic communication or information technology platforms, such as the internet, mobile devices, and computer networks. This type of fraud encompasses various forms, including identity theft, phishing scams, and hacking attacks.

Identity theft occurs when an individual’s personal information, such as their name, address, email credentials, passwords, National ID card number, KRA PIN number, phone number, and date of birth, is fraudulently obtained by a perpetrator. Subsequently, this stolen information is utilized to gain unauthorized access to the victim’s investment portfolio, establish fraudulent insurance policies, or make false claims.

Phishing scams represent another form of cyber fraud. These scams involve the use of fraudulent emails or websites that mimic legitimate company communications. The objective is to deceive the recipient into divulging sensitive information or unwittingly downloading malware onto their device.

To shield themselves against cyber fraud, consumers should exercise caution and vigilance with their personal information. This includes using robust and unpredictable passwords, refraining from interacting with suspicious emails or websites, and regularly monitoring their financial accounts for any unusual transactions. It is crucial to report any suspected instances of digital fraud immediately to the relevant company and appropriate authorities.