I’ve assembled a pretty good team to fight insurance fraud in North Carolina at the Department of Insurance. I’ve more than tripled the number of special agents fighting fraud since I first took office in January 2017. I’ve hired a legal team to help local district attorneys prosecute fraud cases and have formed alliances with multiple state and federal agencies to battle this white-collar crime.
Our investment is paying off. Last year our fraud fighting efforts recovered $6.4 million in fraudulent expenditures. So far this year, our fraud fighting team has made more than $20 million in recoveries. Our Criminal Investigations Division made 380 arrests and obtained 199 convictions in 2025.
But we’re only making a dent in combatting insurance fraud. According to a 2022 study conducted for the Coalition Against Insurance Fraud, such actions cost Americans $308.6 billion a year. That’s $3,800 a year for a family of four.
I need you to help us fight insurance fraud. You can help by choosing to personally abstain from fraud, being on guard when others try to entice you into a fraudulent action and reporting fraud if you suspect.
Insurance fraud is defined as the intentional providing of false or misleading information, or withholding of material information, as a part of an insurance transaction.
Here are some examples of insurance fraud so you can recognize it and avoid it:
- A motorist who didn’t have collision insurance could have a crash, call their insurance company to add collision coverage and then claim the wreck occurred after the collision coverage was added.
- Someone could rent a moving truck and stage an accident with a friend. Then they’d fake an injury to collect on the trucking company’s insurance.
- A worker could fabricate an injury or exaggerate a legitimate injury to claim additional workers’ compensation money.
- A homeowner or renter could sell expensive jewelry to a pawn shop and then file a homeowners’ or renters’ insurance claim, saying the jewelry was stolen.
- A policyholder could misrepresent information on an insurance application to obtain a lower premium.
- Someone could create fraudulent healthcare provider invoices on a computer to obtain payments for care they did not receive.
- A provider could bill the insurance company for services not provided, or upcharge for services that were provided.
Fraud affects you every time you pay an insurance premium. Some estimate that 20 cents on every premium dollar goes toward offsetting the cost of fraud.
If you suspect insurance fraud, you may anonymously report it by calling the Department of Insurance’s Criminal Investigations Division at 919-807-6840 or toll free from anywhere in North Carolina at 888-680-7684.
You may also report it online at www.ncdoi.gov.