Insurance Fraud

Insurance fraud investigations and verifications

Audits and investigations in the areas of insurance fraud (§265 of the German Criminal Code – StGB) and fraud to the detriment of insurance companies (§263 of the German Criminal Code – StGB).

Insurance fraud is a social problem, and the cases reported annually are only the tip of the iceberg. The number of unreported cases is many times higher, and the sometimes exorbitantly high losses inevitably lead to an increase in insurance rates or a reduction in insurance benefits.

This in turn influences the decision of potential insurance customers.

Possible causes

  • Property damage

    • Fire
    • Tap water
    • Burglary (high-value household goods)
    • Burglary (machine parts; IT accessories)
    • Business interruption
    • Vandalism
  • Body injury

    • Automobile Liability Insurance: covering up own damage or exaggerating description of injuries, negative impacts, loss of earnings (household management damage)
    • General liability: redefining own damage or exaggerating description of injuries, negative impacts, loss of earnings (household management damage)

  • Motor vehicle damage

    • Automobile Liability Insurance – provoked, faked (paper accidents) and manipulated accident events
    • Comprehensive and partial coverage: partial or total loss, fire damage, covering up drunk and drugged driving, racing events

  • Life/Health/Occupational disability

    • Commission fraud
    • Fake death, injuries, diseases
  • Accident

    • Fake and exaggerated injury reports
    • Self-mutilation
  • Transport and technical insurance

    • Cargo theft
    • Data theft

Offer – Services

  • Modern and flexible methods of fraud detection and fraud prevention.

  • Advice on recognizing special fraud schemes (modi operandi).
  • Support in saving unjustifiably claimed damage amounts.
  • ECRA GmbH is supported by a well-founded specialist network, which is trained in investigative and legal matters, as well as in special insurance matters.

Investigation

Investigations in the area of white-collar crime

As soon as you learn of a suspected fraudulent act, your next steps are of great importance.
Expectations in dealing with white-collar crime have also increased among employees, business partners and authorities.
Wrong or too slow reactions have a big impact in individual cases and worsen the damage.
A professional investigation team can quickly gain reliable findings. Correct analysis and the right measures are crucial.

We investigate the nature and extent of fraudulent acts, irregularities and breaches of duty.

Possible causes

  • Criminal acts (fraud, theft, embezzlement etc.)
  • Disregard of regulations (money laundering law, data protection laws etc.)
  • (Anonymous) tips.
  • Compliance (violations of internal guidelines or code of coduct).
  • Data protection (data breaches and data leaks).
  • Finance (CEO fraud, capital distortion, fake transactions and wire transfers etc.).

Our offer – Services

  • The goal is to verify or falsify suspicions, clarify facts, identify perpetrators and quantify any damage caused.
  • Consideration of local legislation and data protection regulations in order to maintain their authenticity in court.
  • Assessment of tips and evaluation of whistleblowing systems.
  • Interviewing relevant persons, taking into account employment and data protection regulations.
  • Considering cultural and linguistic characteristics.

Open Source Forensic

Research and analysis of data on the public web

Open Source Intelligence (OSINT) uses information from open, freely available sources to gain relevant insights.
SOCMINT stands for Social Media Intelligence, and this refers to the processing of information from user generated content on social media platforms.

Humant Intelligence (HUMINT) ncludes all forms of interpersonal contact within a network.

ECRA GmbH uses these sources of information in a goal-oriented manner, both via primary and secondary sources.

Possible causes

  • Manipulation of insurance claims with participation of the circle of acquaintances.
  • Formation of phantom companies or buyout of company parts/shells.
  • Relocation of company headquarters and change of location.
  • Disappeared assets (valuables or assets).
  • Counterfeiting of brands and products at home and abroad.
  • Violations of competition rules and clauses.

Our offer – Services

  • Researches to complement internal company special and tort audits.
  • Investigation and assessment of new business relationships.
  • Tracing of publicly available valuables and assets.
  • Asset tracing in the case of moved or concealed assets. Assistance with “asset stripping”.
  • Analysis of market positions and competitive environment.
  • Support in recruitment processes and identification of threats in the context of so-called “blacklists”.
  • Summarize and visually illustrate networks.

Anti-Fraud-Management

Dealing with fraudulent activities as a cross-sectional task

Fraud, money laundering, corruption or embezzlement: white-collar crime causes damages in the billions every year. Companies must always be active to prevent any form of white-collar crime and internal corporate crime.

With the Anti-Fraud Management Assessment, ECRA GmbH can not only support you in evaluating your measures to protect against white-collar crime, but also point out solutions and methods to improve preventive measures.

Fraud Management is understood as a cross-sectional task/responsibility, in which almost all organizational units are to be directly/indirectly involved. Depending on the calculated prognosis of a possible loss, work must be carried out on a departmental basis and measures must be bundled.

An effectively implemented and continuously performed AFM serves to prevent, detect and prosecute deliberate violations.

Possible causes

  • Key factor human being

    • Profiling
    • Workplace Violance
    • Social Engineering and Threat Management
    • Fraud and embezzlement
    • Revealing of trade and business secrets/li>
    • Product and brand piracy
    • Corruption offenses

  • Legal basics

    • Employment law
    • Corporate law
    • Administrative Offences Act
    • Criminal Code
    • Law against unfair competition
    • Data protection and employee control

Our offer – Services

  • Introduction and development of an Anti Fraud Management System with different strategic components.
  • Control, evaluation and analysis of the Fraud Management System through existing performance indicators of the Fraud Prevention Organization. (Basis-measures-action).
  • Fraud auditing support for high-risk corporate units, business units, corporate processes and sub-processes in the area of fraud.
  • Implementation of fraud prevention measures, human resources management, corruption prevention as well as the basics of money laundering.
  • Identification of fraud cases by means of whistleblowing systems and analysis of anonymous tips or forgery detection.
  • Management of fraud cases as a cross-sectional task through various procedures for special investigations, dealing with investigating authorities and determining investigative methods and analytics.

Compliance Assurance

Consulting and support in the area of compliance and CM systems

Today, compliance management systems (CM systems) are an important component of entrepreneurial activity.

Companies must meet legal requirements and observe compliance rules.

ECRA GmbH analyses the current status and determines a need for action.

The auditing approaches are based on the Auditing Standard 980 published by the Institute of Public Auditors in Germany (IDW) under the umbrella of the seven compliance elements.

Possible causes

  • Evidence of compliance of due diligence and organisational duties with regard to compliance.
  • Legal requirements and prerequisites.
  • Identification and findings of new vulnerabilities.

  • Further development of internal organisational and work instructions.

  • New strategic decisions and significant organisational changes in operational areas.

Our offer – Services

  • Checking the actual effectiveness of your CMS.
  • Advice on the adequacy, effectiveness and possible implementation of your CMS.
  • Elaboration of new and current compliance risks.
  • Monitoring and evaluation of company policies, procedures and measures taken to address deficiencies.
  • Audits independent of the respective sector (industry, trade, banking, insurance, etc.).
  • Recommendations for action as a basis for improving your CMS.
  • Advice on conflicts of interest and support with employee training.

Further Training

for your employees

Trainings

We provide external training for employees, departments and individual coaching.

“There are limits to the human art of deception.”

Sir Arthur Conan Doyle