保险，骗保的有关英语说法 各种保险的英语说法

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骗保从有了保险行业依赖，就出现了。罗马诗人马蒂亚尔（Martial）的一句格言清楚地说明了公元一世纪在罗马帝国就有保险欺诈的现象。

An epigram by the Roman poet Martial provides a clear evidence the phenomenon of insurance fraud was already known in the Roman Empire during the First Century AD:
   Tongilianus, you paid two hundred for your house;
    An accident too common in this city destroyed it.
    You collected ten times more. Doesn't it seem, I pray,
    That you set fire to your own house, Tongilianus?"
    Book III, No. 52


骗保的英语怎么说呢？行骗是犯罪的一种，所以先知道说保险方面的犯罪：insurance crime。 Insurance fraud 是“骗保”一个说法。
Insurance fraud is any act committed to defraud an insurance process. It occurs when a claimant attempts to obtain some benefit or advantage they are not entitled to, or when an insurer knowingly denies some benefit that is due. According to the United States Federal Bureau of Investigation, the most common schemes include premium diversion, fee churning, asset diversion, and workers compensation fraud. Perpetrators in the schemes can be insurance company employees or claimants. False insurance claims are insurance claims filed with the fraudulent intention towards an insurance provider.
Insurance fraud has existed since the beginning of insurance as a commercial enterprise. Fraudulent claims account for a significant portion of all claims received by insurers, and cost billions of dollars annually. Types of insurance fraud are diverse and occur in all areas of insurance. Insurance crimes also range in severity, from slightly exaggerating claims to deliberately causing accidents or damage. Fraudulent activities affect the lives of innocent people, both directly through accidental or intentional injury or damage, and indirectly by the crimes leading to higher insurance premiums. Insurance fraud poses a significant problem, and governments and other organizations try to deter such activity.
《中国日报》的报道
National healthcare authorities are investigating reports of healthcare insurance fraud in Anhui province's Taihe county.
有报道称安徽省太和县存在骗保问题，国家医疗机构正在就此进行调查。

an insurance swindle    保险诈骗案
Insurance contracts 保险合同
the insured 投保人(被保险人)：
the insurer 保险方，保险商，保险公司(保险提供者)
insurance applicant 投保人
insurance broker 保险经纪人
insurance business 保险业
insurance certificate 保险凭证，保险证书
insurance claim 保险索赔
insurance clause 保险条款
insurance commission 保险佣金
insurance company 保险公司
insurance conditions 保险条件，保险契约约定条款
insurance coverage 保险范围，保额
insurance declaration sheet (bordereau)(保险申报单(明细表)
insurance document 保险单据
insurance expense 保险费用
insurance industry 保险业
insurance instruction 投保通知，投保须知
insurance law 保险法
insurance on last survivor 长寿保险
insurance policy 保险单，保单
insurance premium 保险费
insurance proceeds 保险赔偿金，保险赔款
insurance rate 保险费率
insurance slip 投保申请书，投保单
insurance underwriter 保险承保人
insurance value (insurance amount) 保险金额
insurant 被保险人
insure 保险；投保
insured amount 保险金额
insurer 保险人，保险商
air transportation risk 航空运输险
average 海损
actual total loss 实际全损
additional premium 附加保险费
additional risk 附加险
aflatoxin risk 黄曲霉素险
breakage of packing 包装破碎险
China Insurance Clauce (CIC)中国保险条款
claim adjustment (settlement of claim) 理赔
claims and arbitration 索赔与仲裁
clash and breakage 碰损，破碎险
co-insurance 共同保险
constructive total loss 推定全损
contractors all risks insurance 建筑工程一切险
cover note 暂保单(证明同意承保的临时文件)； 保险证明
damage caused by heating and sweating 受热受潮险
disbursement policy (船舶)驶费保险单
double insurance 双保险
endowment insurance 养老保险
extra premium 额外保险费
extraneous risks (additional risks) 附加险
failure to delivery ris 交货不到险
floating policy 浮动保险单
franchise (deductible) 免赔额；免赔率
free from/of particular average (FPA, F.P.A.) 平安险
freight policy 运费保险单
partial loss 分损失
particular average (P.A.) 单独海损
perils of the sea 海上风险
policy 保单，保险契约
policy holder 保险客户，保险单持有人
policy package 承保多项内容的保险单
policy proof of interes 保险单权益证明
policy reserves 保险单责任准备金
premium 保险费
premium rate 保险费率
premium rebate 保险费回扣
property insurance 财产保险
rejection risk 拒收险
renew coverage 续保
riks of non-delivery 提货不着险
risk 保险，保险额
risk of bad odou 恶味险，变味险
risk of breakage 破碎险
risk of clashing 碰损险
risk of contamination 污染险
risk of contingent import duty 进口关税险
risk of deterioration 变质险
risk of error 过失险
risk of hook damage 钩损险
risk of import duty 进口关税险
risk of inherent vice 内在缺陷险
risk of labels being washed off 标签破损险
risk of leakage 渗漏险
risk of loss 损失险risk of mould 发霉险
risk of normal loss (natural loss) 途耗或自然损耗险
risk of oil damage 油渍险
risk of packing breakage 包装破裂险
risk of rain and/or fresh water damage 淡水雨淋险
risk of rust 锈蚀险
risk of shortage in quantity 短量险
risk of shortage in weight 短重险
risk of spontaneous combustion 自燃险
risk of sweating and/or heating 受潮受热险
risk of theft, pilferage and nondelivery (TRND)盗窃、提货不着险
risk premium 风险贴水、风险溢价
sickness insurance 疾病保险
social insurance 社会保险
special additional risk 特别(特殊)附加险survey at jetty risk 码头检验险
survey in customs risk 海关检验险
the insured 受保人，被保险人
the Peopled Insurance Company of China 中国人民保险公司
Theft, Pilferage and Non-delivery (PTND, P.T.N.D) 偷窃、提货不着险
time policy 定期保险单
under deck risk 舱内险
underwriter 保险商(指专保水险的保险商)，保险公司
total loss 全部损失
transportation insurance 运输保险
valued policy 定值保险单
voyage policy 航程保险单
with particular average(WPA) 水渍险，基本险，单独海损赔
war risk 战争险

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日前，有媒体报道称，在安徽省太和县，多家医院以“免费”套路拉拢无病或轻症老人住院，涉嫌套取医保基金。记者从国家医保局了解到，针对安徽省太和县多家医院骗保问题，国家医保局已第一时间责成安徽省医疗保障局迅速查明情况，依法依规处理，并在全省范围内加大监管力度，严肃查处违规骗保行为，维护医保基金安全。

【新闻】

请看《中国日报》的报道

National healthcare authorities are investigating reports of healthcare insurance fraud in Anhui province's Taihe county.

有报道称安徽省太和县存在骗保问题，国家医疗机构正在就此进行调查。

【讲解】

insurance fraud是骗保。
国家医疗保障局周三宣布了这一消息，此前两天，新京报报道称，太和县四家医院伪造记录（forged records）进行骗保索赔（make fraudulent insurance claims）。
据称，这些非法行为发生在一家公立医院（public hospital）和三家私立医院，包括为不需要治疗的病人提供假住院证明（fake hospitalization documents），以便政府支付其住院费用（pay for their hospital stays）。
其中，王大爷在私立东方医院出院（discharged）三天后又到公立太和县第五人民医院住院治疗（hospitalized）。
王大爷告诉新京报，“我今年总共住了九次院（hospitalized nine times），差不多住了三个月，哪家医院不花钱（free hospitalization）就去哪家。”
记录显示，这些病人都接受了治疗（received treatment）。
在另一个案例中，一名假病人（fake patient）在太和东方医院住院期间一共花费1817.32元，其中医保报销（covered by healthcare insurance）1318.83元，个人需支付498.49元。由于入院时一次性缴纳500元押金（deposit），办理出院手续时医院返还了300元，住院6天实际花费（actual cost）200元。
据《新京报》报道，因为医院提供免费体检（free physical examinations），所以有一些人愿意与医院合作。
报道发现，中介（intermediary agents）充当了医院和假病人之间的桥梁。在某些情况下，中介会开车将这些人从家里接到医院，出院后，中介再安排车辆（arrange for vehicles）将人送回去。
国家医疗保障局表示，已第一时间责成安徽省医疗保障局迅速查明情况，严肃查处（sternly punish）违规骗保行为，维护医保基金安全（protect the security of healthcare funds）。
安徽省纪委监委已调查组（investigation team）赴太和县，指导督导市县联合调查组对媒体报道的太和县多家医院涉嫌骗保问题开展调查。
公开报道显示，2018年1月，安徽合肥某公立医院被曝存在代病人刷社保卡、挂床住院等涉嫌骗取医保基金（fraudulent healthcare funds）的问题。该院领导被撤职（removed from their positions），8名违规医务人员（medical personnel）被处以暂停七个月执业活动（banned from practicing medicine for seven months）的处罚，其中情节严重、影响恶劣的2名医务人员予以解聘。

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骗保产生的原因，无非是利益
The "chief motive in all insurance crimes is financial profit".[2] Insurance contracts provide both the insured and the insurer with opportunities for exploitation.

According to the Coalition Against Insurance Fraud, the causes vary, but are usually centered on greed, and on holes in the protections against fraud.[4] Often, those who commit insurance fraud view it as a low-risk, lucrative enterprise. For example, drug dealers who have entered insurance fraud [5] think it's safer and more profitable than working street corners. Compared to those for other crimes, court sentences for insurance fraud can be lenient, reducing the risk of extended punishment. Though insurers fight fraud, some pay suspicious claims anyway, as settling such claims is often cheaper than legal action.

Another basis for fraud is over-insurance, in which someone insures property for more than its real value.[2] This condition can be difficult to avoid, especially since an insurance provider might sometimes encourage it to obtain greater profits.[2] This lets fraudsters profit by destroying their property, because they receive an insurance payout greater than the value of the property. The most common forms of insurance fraud are re-framing a non-insured damage to make it an event covered by insurance, and inflating the value of the loss.[6]

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骗保造成的损失
Losses due to insurance fraud

It is hard to place an exact value on the money stolen through insurance fraud. Insurance fraud is deliberately undetectable, unlike visible crimes such as robbery or murder. As such, the number of cases of insurance fraud that are detected is much lower than the number of acts that are actually committed.[2] The best that can be done is to provide an estimate for the losses that insurers suffer due to insurance fraud. The Coalition Against Insurance Fraud estimates that in 2006 a total of about $80 billion was lost in the United States due to insurance fraud.[7] According to estimates by the Insurance Information Institute, insurance fraud accounts for about 10 percent of the property/casualty insurance industry's incurred losses and loss adjustment expenses.[8] The National Health Care Anti-Fraud Association estimates that 3% of the health care industry's expenditures in the United States are due to fraudulent activities, amounting to a cost of about $51 billion.[9] Other estimates attribute as much as 10% of the total healthcare spending in the United States to fraud—about $115 billion annually.[10] According to the FBI, non-health insurance fraud costs an estimated $40 billion per year, which increases the premiums for the average U.S. family between $400 and $700 annually.[1] Another study of all types of fraud committed in the United States insurance institutions (property-and-casualty, business liability, healthcare, social security, etc.) put the true cost at 33% to 38% of the total cash flow through the system. This study resulted in the book title "The Trillion Dollar Insurance Crook" by J.E. Smith. In the United Kingdom, the Insurance Fraud Bureau estimates that the loss due to insurance fraud in the United Kingdom is about £1.5 billion ($3.08 billion), causing a 5% increase in insurance premiums.[11] The Insurance Bureau of Canada estimates that personal injury fraud in Canada costs about C$500 million annually.[12] Indiaforensic Center of Studies estimates that Insurance frauds in India costs about $6.25 billion annually.[13]

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Hard vs. soft fraud

Insurance fraud can be classified as either hard fraud or soft fraud.[14]

Hard fraud occurs when someone deliberately plans or invents a loss, such as a collision, auto theft, or fire that is covered by their insurance policy[15] in order to claim payment for damages. Criminal rings are sometimes involved in hard fraud schemes that can steal millions of dollars.[16]

Soft fraud, which is far more common than hard fraud, is sometimes also referred to as opportunistic fraud.[14] This type of fraud consists of policyholders exaggerating otherwise legitimate claims. For example, when involved in an automotive collision an insured person might claim more damage than actually occurred. Soft fraud can also occur when, while obtaining a new health insurance policy, an individual misreports previous or existing conditions to obtain a lower premium on the insurance policy.[14]

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Types of insurance fraud
Life insurance
See also: Category:Murderers for life insurance money

The majority of life insurance fraud occurs at the application stage, involving applicants misrepresenting their health, their income, and other personal information in order to get a cheaper premium. As more and more insurance amendments can be performed online or over the telephone, identity theft has become an enabling crime that can lead to the amendment of life insurance terms to benefit a fraudster; for example, by adding a second stolen identity as a new beneficiary.[citation needed]

Life insurance fraud may involve faking death to claim life insurance. Fraudsters may sometimes turn up a few years after disappearing, claiming a loss of memory.[17]

An example of life insurance fraud occurred in the case of John Darwin, a former teacher and prison officer who turned up alive in December 2007, five years after he was thought to have died in a canoeing accident, claiming to have no memory of the period after his disappearance.

Similarly, former British Government minister John Stonehouse went missing in 1974 from a beach in Miami but was discovered living under an assumed name in Australia. He was subsequently extradited to Britain and imprisoned for seven years on charges of fraud, theft, and forgery.

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Health care insurance
See also: Medicare fraud and Health care fraud

Health insurance fraud is described as an intentional act of deceiving, concealing, or misrepresenting information that results in health care benefits being paid to an individual or group.

Fraud can be committed either by an insured person or by a provider. Member fraud consists of claims on behalf of ineligible members and/or dependents, alterations on enrollment forms, concealing pre-existing conditions, failure to report other coverage, prescription drug fraud, and failure to disclose claims that were a result of a work-related injury.

Provider fraud consists of claims submitted by bogus physicians, billing for services not rendered, billing for higher level of services, diagnosis or treatments that are outside the scope of practice, alterations on claims submissions, and providing services while medical licenses are either suspended or revoked. Independent medical examinations debunk false insurance claims and allow the insurance company or claimant to seek a non-partial medical view for injury-related cases.

According to the Coalition Against Insurance Fraud, health insurance fraud depletes taxpayer-funded programs like Medicare, and may victimize patients in the hands of certain doctors.[18] Some scams involve double-billing by doctors who charge insurers for treatments that never occurred, and surgeons who perform unnecessary surgery.[19]

According to Roger Feldman, Blue Cross Professor of Health Insurance at the University of Minnesota, one of the main reasons that medical fraud is such a prevalent practice is that nearly all of the parties involved find it favorable in some way. Many physicians see it as necessary to provide quality care for their patients. Many patients, although disapproving of the idea of fraud, are sometimes more willing to accept it when it affects their own medical care. Program administrators are often lenient on the issue of insurance fraud, as they want to maximize the services of their providers.[20]

The most common perpetrators of healthcare insurance fraud are health care providers. One reason for this, according to David Hyman, a Professor at the University of Maryland School of Law, is that the historically-prevailing attitude in the medical profession is one of "fidelity to patients".[21] This incentive can lead to fraudulent practices such as billing insurers for treatments that are not covered by the patient's insurance policy. To do this, physicians bill for a different service that the policy covers, rather than the service they rendered.[22]

Another motivation for insurance fraud is a desire for financial gain. Public healthcare programs such as Medicare and Medicaid are especially conducive to fraudulent activities, as they are often run on a fee-for-service structure.[23] Physicians use several fraudulent techniques to achieve this end. These can include "up-coding" or "upgrading", which involve billing for more expensive treatments than those actually provided; providing, and subsequently billing for, treatments that are not medically necessary; scheduling extra visits for patients; referring patients to other physicians when no further treatment is actually necessary; "phantom billing", billing for services not rendered; and "ganging", billing for services to family members or other individuals who are accompanying the patient but who did not personally receive any services.[23]

Perhaps the greatest total dollar amount of fraud is committed by the health insurance companies themselves. There are numerous studies and articles detailing examples of insurance companies intentionally not paying claims and deleting them from their systems,[24] denying and cancelling coverage, and the blatant underpayment to hospitals and physicians beneath what are normal fees for care they provide.[25] Although difficult to obtain the information, this fraud by insurance companies can be estimated by comparing revenues from premium payments and expenditures on health claims.

In response to the increased amount of health care fraud in the United States, Congress, through the Health Insurance Portability and Accountability Act of 1996 (HIPAA), has specifically established health care fraud as a federal criminal offense with punishment of up to ten years of prison in addition to significant financial penalties.

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Automobile insurance

Fraud rings or groups may fake traffic deaths or stage collisions to make false insurance or exaggerated claims and collect insurance money. The ring may involve insurance claims adjusters and other people who create phony police reports to process claims.[26]

The Insurance Fraud Bureau in the UK estimated there were more than 20,000 staged collisions and false insurance claims across the UK from 1999 to 2006. One tactic fraudsters use is to drive to a busy junction or roundabout and brake sharply causing a motorist to drive into the back of them. They claim the other motorist was at fault because they were driving too fast or too close behind them, and make a false and inflated claim to the motorist's insurer for whiplash and damage, which can pay the fraudsters up to £30,000.[27] In the Insurance Fraud Bureau's first year or operation, the usage of data mining initiatives exposed insurance fraud networks and led to 74 arrests and a five-to-one return on investment.[28]

The Insurance Research Council estimated that in 1996, 21 to 36 percent of auto-insurance claims contained elements of suspected fraud.[29] There is a wide variety of schemes used to defraud automobile insurance providers. These ploys can differ greatly in complexity and severity. Richard A. Derrig, vice president of research for the Insurance Fraud Bureau of Massachusetts, lists several ways that auto-insurance fraud can occur,[30] such as:
Staged collisions

In staged collision fraud, fraudsters use a motor vehicle to stage an accident with the innocent party. Typically, the fraudsters' vehicle carries four or five passengers. Its driver makes an unexpected manoeuvre, forcing an innocent party to collide with the fraudster's vehicle. Each of the fraudsters then files claims for injuries sustained in the vehicle. A "recruited" doctor diagnoses whiplash or other soft-tissue injuries that are hard to dispute later.

Other examples include jumping in front of cars as done in Russia. The driving conditions and roads are dangerous with many people trying to scam drivers by jumping in front of expensive-looking cars or crashing into them. Hit and runs are very common and insurance companies notoriously specialize in denying claims. Two-way insurance coverage is very expensive and almost completely unavailable for vehicles over ten years old–the drivers can only obtain basic liability. Because Russian courts do not like using verbal claims, most people have dashboard cameras installed to warn would-be perpetrators or provide evidence for/against claims.[31]
Exaggerated claims

A real accident may occur, but the dishonest owner may take the opportunity to incorporate a whole range of previous minor damage to the vehicle into the garage bill associated with the real accident. Personal injuries may also be exaggerated, particularly whiplash.[32] Insurance fraud cases of exaggerated claims can also include claiming damage to the car that is not from the accident reported in the claim.[33]

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Examples

Examples of soft auto-insurance fraud include filing more than one claim for a single injury, filing claims for injuries not related to an automobile accident, misreporting wage losses due to injuries, and reporting higher costs for car repairs than those that were actually paid. Hard auto-insurance fraud can include activities such as staging automobile collisions, filing claims when the claimant was not actually involved in the accident, submitting claims for medical treatments that were not received, or inventing injuries.[34] Hard fraud can also occur when claimants falsely report their vehicle as stolen. Soft fraud accounts for the majority of fraudulent auto-insurance claims.[29]

Another example is that a person may illegally register their car to a location that would net them cheaper insurance rates than where they actually live, sometimes called rate evasion. For example, some drivers in Brooklyn have Pennsylvania license plates, because insurance rates for a car registered to an address in rural Pennsylvania are much less than they are in Brooklyn. Another form of automobile insurance fraud, known as "fronting", involves registering someone other than the real primary driver of a car as the primary driver of the car. For example, parents might list themselves as the primary driver of their children's vehicles to avoid young driver premiums.

"Crash for cash" scams may involve random unaware strangers, set to appear as the perpetrators of the orchestrated crashes.[35] Such techniques are the classic rear-end shunt (the driver in front suddenly slams on the brakes, possibly with brake lights disabled), the decoy rear-end shunt (when following one car, another one pulls in front of it, causing it to brake sharply, then the first car drives off) or the helpful wave shunt (the driver is waved into a line of queuing traffic by the scammer who promptly crashes, then denies waving).[36]

Organized crime rings can also be involved in auto-insurance fraud, sometimes carrying out schemes that are very complex. An example of one such ploy is given by Ken Dornstein, author of Accidentally, on Purpose: The Making of a Personal Injury Underworld in America. In this scheme, known as a "swoop-and-squat", one or more drivers in "swoop" cars force an unsuspecting driver into position behind a "squat" car. This squat car, which is usually filled with several passengers, then slows abruptly, forcing the driver of the chosen car to collide with the squat car. The passengers in the squat car then file a claim with the other driver's insurance company. This claim often includes bills for medical treatments that were not necessary or not received.[37]

An incident that took place on Golden State Freeway June 17, 1992, brought public attention to the existence of organized crime rings that stage auto accidents for insurance fraud. These schemes generally consist of three different levels. At the top, there are the professionals—doctors or lawyers who diagnose false injuries and/or file fraudulent claims and these earn the bulk of the profits from the fraud. Next are the "cappers" or "runners", the middlemen who obtain the cars to crash, farm out the claims to the professionals at the top, and recruit participants. These participants at the bottom-rung of the scheme are desperate people (poor immigrants or others in need of quick cash) who are paid around US$1000 to place their bodies in the paths of cars and trucks, playing a kind of Russian roulette with their lives and those of unsuspecting motorists around them. According to investigators, cappers usually hire within their own ethnic groups. What makes busting these staged-accident crime rings difficult is how quickly they move into jurisdictions with lesser enforcement, after a crackdown in a particular region. As a result, in the US several levels of police and the insurance industry have cooperated in forming task forces and sharing databases to track claim histories.[38][39]

In the United Kingdom, there is an increasing incidence of false whiplash claims to car insurance companies from motorists involved in minor car accidents (for instance; a shunt). Because the mechanism of injury is not fully understood, A&E doctors have to rely on a patient's external symptoms (which are easy to fake). Resultingly, "no win no fee" personal injury solicitors exploit this "loophole" for easy compensation money (often a £2500 payout). Ultimately this has resulted in increased motor insurance premiums, which has had the knock-on effect of pricing younger drivers off the road.

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Property insurance

Possible motivations for this can include obtaining payment that is worth more than the value of the property destroyed, or to destroy and subsequently receive payment for goods that could not otherwise be sold. According to Alfred Manes, the majority of property insurance crimes involve arson.[40] One reason for this is that any evidence that a fire was started by arson is often destroyed by the fire itself. According to the United States Fire Administration, in the United States there were approximately 31,000 fires caused by arson in 2006, resulting in losses of $755 million.[41]
Unemployment insurance

Unemployment insurance fraud can occur when someone who is not unemployed or who steals the identity of another individual obtains unemployment benefits to which he or she is not entitled. During 2020, there was a significant spike of unemployment fraud in the United States.[42]
Premium fraud

In addition to fraudulent claims, insurers can lose premium because customers inaccurately describe the risk, causing less premium to be charged. This can happen for any type of insurable risk and is most noteworthy in workers compensation insurance, where insureds report fewer employees, less payroll, and less risky employees than is actually intended to be covered by the policy.[43]
Council compensation claims

The fraud involving claims from the councils' insurers suppose staging damages blamable on the local authorities (mostly falls and trips on council owned land) or inflating the value of existing damages.[44]