Pill mill is a term used primarily by local and state investigators to describe a doctor, clinic or pharmacy that is
prescribing or dispensing powerful narcotics inappropriately or for non-medical reasons.
(CBSNEWS What's A Pill Mill?
An agent uses a date earlier than the date a policy actually goes into effect (effective date). This may
lead to violation of the Idaho Insurance Statues
An agent convinces a policyholder to cash out an already existing policy and purchase a new one, even though
it may not be in their best interest. (NAIC
A patient sees multiple doctors, sometimes simultaneously, without informing any of them about the multiple
treatments. The purpose of this is to get a prescription of a drug more than legitimate medical need in order
to feed the patient’s addiction to that drug.
Drive Down / Wave Down
When a driver (victim) is trying to merge into traffic, a dishonest driver slows down and waves a victim forward.
He then crashes into the victim’s car, but denies waving the victim into traffic and blames the accident on the
Explanation of Benefit
EOB explains what medical treatments and services were performed and the doctor’s fees
the insurance company paid for the covered individual.
Some examples are:
- Create applications containing fictitious information;
- Create fictitious insurance documents to show an individual has insurance;
- Forge an individual’s signature without their knowledge. (NAIC )
An agent offers valuable items to a potential or existing customer in order to persuade an individual.
Insurance kickbacks are benefits given to a person or company in return for doing some task or favor.
Usually it does not benefit a consumer.
For example, a consumer who put less than 20 percent down for the home purchases is forced to purchase policies
from specific mortgage insurer in order to protect the bank's investment. The mortgage insurer would then pay
the bank a portion of their profits.
Misappropriation of Premiums
An agent fails to send premiums to the insurer and spends the money for personal use.
A dishonest driver, teaming up with passengers, keeps an eye on the driver (victim) behind them, waiting for the
victim to become distracted. Then the dishonest driver slams on the brakes, forcing the victim to rear end them.
The victim is often found at fault since they rear-ended a car while distracted.
An agent offers a return a portion of premiums, or their commission in order to persuade a potential or existing
Rebate is prohibited in Idaho by Idaho Statute,
This usually takes place at a busy intersection with dual left-lanes. When a car in the inner lane (victim) changes
lanes, a dishonest driver in the outer lane deliberately accelerates, forcing the victim to side-swipe the
dishonest driver’s car.
An agent adds extra coverage into a customer’s policy without its permission or knowledge. This could add a few
hundred dollars a year to the premiums while the agent increases its commission.
Stranger Originated Life Insurance
STOLI which involves a group of investors funding the purchase of a
life insurance policy for someone they have no insurance interest in.
Suitability in annuity transactions. Per Idaho Rule
, the insurers and
producers must make “reasonable efforts” to obtain the consumer’s “suitability information” prior to recommending
a particular annuity to the consumer.
The purpose of this regulation is to prevent unsuitable sales to consumers. Agents who fail to comply with the
suitability rules may face administrative action.
Swoop and Squat
It usually involves 2 cars (a squat and swoop car) driven by the con artists, and 1 driven by the victim.
While the squat car is driving in front of a victim, the swoop car will suddenly cut in front of the squat car.
Usually the victim doesn’t have enough time to react and rear-ends the squat car.
Often the squat car has passengers who pretend to have painful back or neck injuries, regardless of the impact
speed, and make large collision and injury claims against the victim’s auto policy.