DAY 2 – Insurance Fraud Expo Presentations
September 09, 2008 | 08:30 am to 11:30 am
Provider Facility Inspection & Clinic Equipment Demonstration
Dr. Rick Wakefield
International Healthcare Consultants
Our training offers a "hands-on" demonstration of clinical equipment and the clinical environment. The class provides an opportunity for the trainee to participate in a demonstration of the physical examination and the use of common clinical equipment. This will enhance their understanding of comparing medical record findings with office equipment used in treatment, diagnosis and billing codes submitted to third party payors. This specialized training is called ERT or "Environment of Relevance Training". Classroom retention rates are exponentially increased when the trainee is immersed in a "hands-on" environment. This training allows Investigators to expand their knowledge using the "ERT" experience and immediately put their new skills to use.
Management Panel ~ TA-2 & TB2 - Full Day Track
Nelson Vazquez, Liberty Mutual
Glenn Wolf, Liberty Mutual
Anthony Golowski II, Podvey Meanor Catenacci Hildner Cocoziello & Chattman, P.C.
John Sargent, Metlife
Travis Dye, ChoicePoint
The Management Panel sessions will offer a series of presentations by experienced SIU Managers and Attorneys who will focus on a myriad of management related issues that include:
- Strategic management and planning for the future
- Proper application of your resources
- Issues SIU Managers routinely face when evaluating insurance fraud initiatives
- Managing a SIU operation outside of the P&C (ie: dental, disability, life, long term care)
- Utilizing Predictive Modeling to Help SIU Managers Overcome the Adjuster Talent Gap
Ethics for Professional Investigators ~ (Required for CIFI re-certification)
Steve Piper, Travelers
This course provides for an interactive discussion around the necessary conduct required within our industry to exhibit the highest ethical standards for fraud investigators. The training will also provide an overview using ethics as the basic component needed for long term personal success within the insurance industry as well as the legal implications of unethical conduct.
INTERNATIONAL TRACK ~ Money Laundering in Offshore Havens & How to fight Insurance Fraud in Norway, Europe and Globally
PART I
Bob Lessemun, Bob Lessemun Investigations, Inc.
A former detective superintendent of the Royal Turks and Caicos Police and a former Scotland Yard trained hostage negotiator with 32 years undercover police experience outlines for the first time how a major international money launderer was captured with the use of under cover police officers, Government money, gathering of intelligence over an 11 year span and the subsequent execution of search warrants at night, bypassing alarm systems and copying offshore documents and hard drives in an offshore haven in the Caribbean.
This lecture will show how money is laundered, where it is laundered and how it returns from the grey to mainstream.
How money launderers can be captured with joint operations between countries law enforcement. The pitfalls and problems encountered along the way.
PART II
Stein Naustdal and Jan Robert Edvardsen, TrygVesta Insurance
With the increase in air travel making the world a smaller place, this has resulted in an increase in the number of claims submitted by people traveling abroad. Many of these are dubious in nature, if not outright fraudulent. Because of this, networking has become of increased importance to every SIU around the world. We have to share our experience and knowledge in investigating such claims.
The aim of this presentation is to give an insight into the latest fraud trends in Europe & to demonstrate how Investigation Units are organized in the different European countries. As a consequence it is hoped that the importance of the role carried out by IASIU Europe will be demonstrated.
Furthermore, examples will be given of how criminals attempt to launder money through insurance companies & provide case studies to demonstrate the various points in the presentation.
LOW COST-HIGH RETURN: Making the most of your assets in an automobile ring investigation
Cory Cox, Arkansas Insurance Department Criminal Investigation Division
Ellen Withers, State Farm Insurance
Each presenter (insurance investigator and director of the DOI criminal investigation) brings a unique perspective to the case and will share this with the audience in the form of a moderated panel discussion and questions from the audience. Topics of discussion include how the ring was discovered, how it was investigated, how the initial referral of 22 cases grew to nearly 50 cases, how the different entities applied teamwork to encompass this large investigation and how the case was brought to criminal prosecution. The audience will be encouraged to participate with questions in every aspect of the presentation.
Conjunction Junction - What Function Does Legal/Illegal Status of Claimant Have on a Property Claim
Olivia O. Bissell, Bissell, Obas & Federle, LLP
The immigration status (whether legal or illegal) of a claimant may be critical to Property (Auto, Commercial or Homeowners) claims decisions including whether the claimant has a right to own the property claimed as damaged and/or stolen and to assert various rights in the claim process.
September 09, 2008 | 01:00 pm to 03:00 pm
WALK THE LINE / SIU Investigation: Rights and Limitations
Wendelyn Walberg, Walberg, Tucker & Holmes, P.C.
Where is the Line? When you, as an investigator, seek certain information, what rights do you have to obtain it and what limitations are there on your ability to investigate. This presentation will provide a framework within which you can evaluate whether your investigations are zealous and thorough, yet legal and justified. Attendees will better understand what defines and creates their right to investigate, and how ethics codes, statutes and tort laws circumscribe those rights.
Investigating the "Crack Ride" Loss -- A Claim Study
Roy Mura, Esq., Mura & Storm, PLLC
Minor Impact "CSI": Let Physics Do The Work
Alan Moore, HSA Engineers & Scientists
Minor impacts can be difficult to investigate; often the vehicles exhibit little or no damage, and the reported injuries are not obvious.
Several accident reconstruction and engineering techniques can help you handle the minor impact claim, and get to the bottom of what happened. What evidence can help you? What misconceptions may get in the way of our work?
The discussion is interspersed with photographs and video of vehicle accidents, both to illustrate the subject and to retain the listeners’ interest. It also includes a hands-on demonstration of Crash Data Recorders, during which the attendees will use the equipment to obtain crash data from a vehicle.
The intent of the course is to provide investigators with an understanding of accident reconstruction and how it can help in the investigation process.
Top 10 Trends in Healthcare Fraud
Kirk J. Nahra, Wiley Rein LLP
This session will review the most significant recent developments in the area of health care fraud, and identify how these developments will affect your company and the insurance industry in its anti-fraud efforts. We will review recent significant cases, important statutory and regulatory developments and developments in connection with government health care fraud investigations.
Protocols, Procedures & Techniques to Effectively Investigate Medical Provider Claims
Jeffrey Rapattoni, Marshall, Dennehey, Warner, Coleman & Goggin
Kathy Aplin, Travelers Insurance
Medical provider fraud is rarely self-evident. The issues at play evolve and allow their participants to receive profitable returns. Most times the payout is worth the risk to suspect medical providers and enterprises as the wrongdoing can be easily concealed or skewed. More often than not, fraud is constantly evolving and becoming more invasive to auto, general liability, and worker’’s compensation claim environments. This continues to result in high exposures, costing companies time and money, both of which are increasingly difficult to recoup.
Tactics and protocols must constantly evolve to be effective to the changing nature of provider based fraud and abuse. This training will explore strategies to confront the issue of provider fraud through the employment of pre-litigation tactics and establishment of claim handling protocols for dealing with suspicious claims. This presentation will focus on procedures that can be implemented to better determine whether or not a company is at risk to significant provider exposure. We will explore in-house options for identifying fraudulent billing practices and present alternatives to conventional investigations. Also, we will discuss pre-litigation legal options that are inexpensive and designed to be more effective than investing in conventional long term litigation.
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