Recent ICAC Cases

13
Jun 2022
Trio charged after ICAC graft probe reveals $37.5m critical illness insurance compensation scam

The ICAC today (June 13) charged three persons, including a former insurance agent and a policyholder, for allegedly conspiring to deceive an insurance company in applications for critical illness and medical insurance claims by arranging cancer patients to pose as relevant policyholders to undergo medical examinations at various clinical institutions so as to obtain required medical certificates. The scam involved 10 insurance policies and the claims amounted to about $37.5 million.

The ICAC investigation arose from a corruption complaint. Upon legal advice from the Department of Justice, Wong Ka-keung, 43, former insurance agent of AIA International Limited (AIA); Lo Chun-kit, 44, driver; and Leung Wai-kin, 40, renovation worker, have been jointly charged with two counts of conspiracy to defraud, contrary to Common Law. Wong alone further faces four similar offences and three counts of forgery, contrary to Section 71 of the Crimes Ordinance.

The defendants will appear in the Eastern Magistrates’ Courts tomorrow (June 14) for mention.

The alleged offences took place between October 2017 and December 2020. At the material time, Wong was an insurance agent of AIA who assisted Lo in taking out two insurance policies with AIA.

Two of the charges allege that Wong, Lo and Leung conspired together with other persons to defraud AIA by dishonestly falsely representing that Lo had been diagnosed with cancer and that the medical expenses incurred were for his treatments; thereby causing and inducing AIA to approve the critical illness and medical expenses claims made by Lo and to pay him compensations in accordance with the two insurance policies took out by Lo.

Four other charges allege that Wong conspired together with other persons to defraud AIA by dishonestly falsely representing that Wong and the two policyholders (the trio) had been diagnosed with different types of cancer; thereby causing and inducing AIA to approve the critical illness claims made by the trio and to pay them compensations in accordance with eight insurance policies taken out by them.

It is alleged that Wong, Lo and other persons falsely represented to AIA that they were diagnosed with different types of critical illness, namely lymphoma, throat, breast, stomach and ovarian cancer. They had allegedly arranged cancer patients, including Leung, to pose as relevant policyholders to undergo examinations at various clinical institutions so as to obtain the required medical certificates.

ICAC investigation revealed that Wong was the handling agent of all of the above 10 insurance policies and the policyholder of six of them. The critical illness and medical expenses claims in relation to those insurance policies amounted to about $37.5 million.

The remaining charges allege that Wong made three false certificates of sickness with the intention that one of the imposters in the scam should use them to induce somebody to accept them as genuine.

AIA has rendered full assistance to the ICAC during its investigation. As the relevant corruption investigation is continuing, the ICAC does not rule out further law enforcement actions.

The ICAC calls on insurance practitioners to adhere to their pledge to integrity and urges members of public and policyholders not to take part in any insurance-related corrupt and illegal activities. To assist the insurance industry to adhere to integrity and prevent corruption and fraud, the Corruption Prevention Department had collaborated with the industry to compile the “Corruption Prevention Guide for Insurance Companies” which assists insurance companies in building and strengthening their corruption prevention capabilities in key operational areas such as claims verification. “Corruption Prevention Guide for Insurance Companies

The ICAC will continue to collaborate with the industry in providing integrity training to insurance practitioners. They may contact the Hong Kong Business Ethics Development Centre of the Community Relations Department. In addition, the ICAC produces corruption prevention resources for insurance companies, insurance practitioners and policyholders. Information is available at the Ethics Promotion Website for the Insurance Industry.

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