Insurance Scams for Beginners- (i) My Little Hospital

The Prestige Hospital, Victoria Island, Lagos

Congratulations on choosing a risk-free, victimless route to earn fast money.



Inventing Your very own hospital is a foolproof way to profit from insurance companies. By following these four simple stages, you ‘ll become rich in just a few short steps


1. find a friend with private medical insurance


2. send him/her a bill from your made-up hospital


3. wait for the money to arrive from the insurer, and share it with your friend


4. repeat steps 1-3 as necessary

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Along the way, look forward to gathering important contacts and admirers Some of the executives you’ll impress are loss adjusters, investigators and claims assessors. And all you need to do is pay attention to the advice. Here’s how to prepare









Medical knowledge Hospital owners/workers are sometimes professional doctors. With a little practice, you can be a medic, too. Of course, you may like to do a little homework so you feel at home in your new role. For example,if you decide you’re going to be an orthopaedic surgeon, get a reliable dictionary and learn to spell the following words: orthopaedic, surgeon, bone, operation. Likewise, if eyes are to be your speciality, watch out for that tricky little extra ‘h’ in ophthalmology. However, most doctors are happy to use everyday terms for medical matters, so don’t hesistate to write ‘pills’ for pharmaceuticals, or ‘bad feet’ for plantar fasciitis.


Remember that the insurer is going to ask about the diagnosis ( A diagnosis is how you describe what was wrong with your friend) Try to be adventurous with your choice of ailment. Claims assessors are easily bored, and will fast-track the more exciting conditions, such as gunshot wounds.


The assessor lives on a distant continent where there are no buffalos, hippos or crocodiles. To add credibility to your claim, ensure that at least one of these creatures is mentioned as the instigator of the injuries you’ve treated.


The more the merrier To save time, it can be a good idea to arrange for several of your friends to be hurt in the same fictitious incident. Loss adjustors report that these are commonplace accidents, unlikely to raise an eyebrow in the claims department:


• heavily-insured staff of firework factory enjoy card game, using barrel of gunpowder as table


• mad camel goes beserk on beach crowded with insured persons


• large (insured) family regarding the view together as balcony collapses


• group of jetsetting insureds share the same holiday caravan, featuring faulty gas cooker






Make sure you choose an impressive name for your establishment The Oxford Dictionary is full of long and imposing words, but perhaps the Omnivorous Hospital may not be your best choice. Try to go for something grand, but relevant. Successful names include the Very Modern Hospital; the Innocent Clinic; the Gomorrah Institute; the All Africa Heart Transplant and Varicose Vein Centre


Saints are always popular, but like the best domain names, most of the good ones have been taken already. There are still plenty of lesser-known ones left, though, and new names are being added to the calendar all the time. Try to select a saint with a relevance to your own speciality. Why not consider one of these?

St Attracta – cosmetic surgery  


St Obitius – gastric banding


St Boniface – maxillo-facial


St Isidora the Simple – psychiatry






Honest accounting


You’re going to have to submit accounts in support of your claims, so get them looking as convincing as you can. This will require some investment of time, care and maybe even money on your part. As well as your hospital name, you’re going to have to have your phone number on the bill, plus lots of other information to make your business appear as important and successful as possible.

A good telephone manner is essential Many 200-bed surgical facilities find it impossible to operate from a single mobile telephone. You really will need to splash out on a land line if you don’t want a call from an investigator (see below). Do not use your home telephone number as it will show up in reverse searches, and may be answered by your ten-year-old son. When you have a brand new number, display it proudly on your false invoice. Then pray that the investigator decides not to ring it. Alternatively, make sure an adult is on hand to answer it day and night, for hospitals are staffed 24/7 and your opponent is likely to be working in a different time zone.


Make sure you, and any relief receptionist, knows who they are and what to say. Bear in mind that exclusive healthcare facilities don’t answer their phone with a fearful ‘Hello”’ Neither do their staff search noisily for their name on a paper list of possible answers, when asked to identify themselves.


If you do get that call, bear in mind that even a professional investigator may have a sense of humour. Be prepared for him to have a discreet chuckle at your expense, by asking you to transfer him to the clinical director of your hospital. If this happens, under no circumstances pretend that you are the clinical director. It is quite possible that the investigator is a real doctor, albeit down on his luck, and if so, you wouldn’t catch him moonlighting as a telephonist.

 In a frivolous mood, he may fire a series of medical questions at you, which you might not be able to answer convincingly. Even if you acquit yourself well, he’ll only ask to be put through to the radiology department, or to speak to a ward sister. You must then either pretend you’ve been accidentally cut off (he’ll be expecting this to happen), or risk what’s left of your dignity by adopting a different accent, or even gender.


If you’ve reached the point where the investigator has interrupted his busy schedule to call you in the middle of the night (your time), it may be that your fake bill was not entirely persuasive. Perhaps you have forgotten to append your address, or worse still, included a truthful description of your location as opposite number 23 bus stop ? Possibly he has somehow identified your official logo as the one you borrowed from that fish cannery on the shores of Lake Victoria?


If you think the investigator seems a little suspicious, could it be that you did not pay sufficient attention to the quality of your paper? He is familiar with the stationery of exclusive hospitals, and knows they do not word-process their own letterheads. They use neither pencil nor a manual typewriter in the preparation of bills, especially those which total U$30,000 like yours. The paper of a bona fide hospital is likely to be thick, weighty, laid and without marks or scars. Rather like the investigator himself, in fact.

You may have decided to recycle an existing document, perhaps for reasons of economy. If so, make sure the investigator’s attention is not drawn to the changes. When erasing incriminating details, ensure that you don’t actually make a hole in the paper, as he will be able to detect it by the simple forensic technique of holding it up against a lightbox (this is investigator-speak for his office window). To be truly effective, correcting fluid needs to be applied to both sides of the paper. (All detectives receive training in deciphering mirror-writing). Do not apply Tip-Ex too thickly, or the investigator will merely chip it off with his penknife.


Similarly, if you cut off the bottom of a document to hide something incriminating, mind your fingers, and plan in advance what tools you need to create a perfect right angle at each corner of the remaining paper. (Your adversary will own a protractor)

If concealing part of a document with a realistic-looking smudge or blot, always use the same ink as the rest of the text, to avoid confusing the investigator unnecessarily. For the illusion of a medical origin, you might consider applying a bloodstain to cover any text you don’t want to be seen. However,this is risky, because your target audience (the claims assessor) will have experienced similar gruesome activity before. S/he will categorise your claim as unhygienic and unsporting. Nothing transports your bill into an evidence bag more quickly than a bloodstain.






The amount of your claim might have raised doubts within the insurance company. Do not be too greedy. Anything over U$ 20,000 for a hospital visit is likely to arouse interest from the claims department. Also, any hospitalisation of more than three months could be considered excessive, unless there are good clinical reasons for the extended stay. If the investigator questions a long hospitalisation, simply tell him you were waiting for a spare part to arrive from Europe. If he asks for more detail, explain that ‘spare part’ is what you doctors call a prosthesis, as he may have forgotten this part of his training.


Finally, always remember that an investigator is like you in many ways – and he’s measured by results. Therefore, the more claims you send in from your hospital, the more popular and feted the investigator will be. He will then be quite happy for you to continue sending in your bills, and adding them to his own database of successful claims. In this way, your friendly, symbiotic relationship may continue for some time.

Enjoy your first journey into the world of insurance fraud, and remember to recommend this article to a friend.




Coming soon


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