Fraud Fighters Weekly: Inside the Mind of the Fraudster

Welcome back to Fraud Fighters Weekly! This week, we’re focusing on something every investigator, adjuster, or SIU specialist needs to sharpen: the ability to read a fraudster before the paperwork even hits your desk.

Fraud isn’t always about fake documents or phony billing—it often begins with a mindset, one that can be uncovered through behavior, language, and subtle patterns. Whether you’re dealing with a shady claimant, an opportunistic employer, or a deceptive provider, learning to read the psychological cues can give you a massive edge.

🧠 Fraud Begins With Psychology

Most insurance fraud falls into one of these three motivation categories:

1. Opportunistic – “Nobody will notice.”
2. Entitled – “I’ve paid into this for years.”
3. Predatory – “This is my business model.”

Understanding the motive helps tailor your investigation: Is this about money, revenge, attention, or habit?

🗣️ Behavioral Red Flags During Interviews

Whether you’re conducting an initial intake, a recorded statement, or a follow-up field interview, here’s what to watch for:

Speech & Language:

• Overly specific or rehearsed stories (fraudsters often “script” their answers)
• Vague details on key facts (“I’m not sure where exactly it happened…”)
• Excessive use of legal or medical jargon
• Evasive responses when asked to explain basic facts (“I’d rather not say” or “You can look it up”)

Body Language (if inconsistent with their baseline):

• Avoids eye contact during critical questions
• Crossed arms, fidgeting, or excessive blinking
• Delayed reactions when answering “yes/no” questions
• Overcompensation—appearing “too cooperative” or “overly offended”

🧠 Tip: Ask the same question at different points in the conversation. Fraudsters often contradict themselves without realizing it.

🕵️♂️ Claim Pattern Red Flags: Behavioral & Lifestyle

Fraudsters often underestimate how visible they are. Use open-source intel and claim patterns to catch these behavioral contradictions:

• Social media activity inconsistent with reported injuries (e.g., hiking, dancing, lifting)
• Check-ins at locations far from home while on disability
• Sudden “losses” or “accidents” following a policy increase or new coverage
• Claim filed shortly after financial hardship (divorce, job loss, bankruptcy)

📘 Psychological Profiling Tools & Techniques

While not formal diagnoses, these tactics help categorize fraud risk and guide your strategy:

1. Baseline Behavior Testing
2. Use the “Pause Test”
3. Behavioral Anchoring
4. Personality Red Flags

🔗 Trusted Resources for Behavioral Interviewing

• 📖 The National Education Institute of Investigation, Behavioral Analysis certification program: https://neii.thinkific.com/courses/behavioralanalysis
• 📚 IASIU’s Behavioral Interviewing for Insurance Fraud
• 🛠️ Coalition Against Insurance Fraud: Fraud Behavior Profiles

Case Example: “The Claimant Who Talked Too Much”

A workers’ compensation claimant reported a back injury and said they couldn’t lift more than 10 pounds. During the interview, they mentioned their gym routine “before the injury” and kept emphasizing how careful they were.

But when asked about their daily pain, they overexplained—with inconsistent details.

Social media showed them helping a friend move a couch—on the same week they claimed to be bedridden. The case was denied, and a fraud referral was submitted to the state DOI.

What’s Next?

In next week’s issue, we’ll tackle surveillance strategy—how to plan, position, and execute smart, defensible surveillance that holds up in court. From timing to location prep to tech tools, we’ll break it all down.

Until then, remember: a good interviewer doesn’t just listen for answers—they watch for behavior. Stay sharp. Stay skeptical. Stay on mission.

— Chris

Want a downloadable “Interview Red Flag” cheat sheet for your team? Reply with “RED FLAGS” and I’ll send it over.