2018 Ohio Joint Insurance Fraud Seminar

Transcription

1 2018 Ohio Joint Insurance Fraud Seminar March 8, 7, Columbus Division of Police James G. Jackson Training Academy 1000 N. Hague Ave., Columbus, OH (614)

2 PURPOSE: The Ohio Chapter of the National Society of Professional Insurance Investigators (NSPII), the National Insurance Crime Bureau (NICB), the Ohio Chapter of the International Association of Special Investigation Units (IASIU), Ohio Auto Theft Investigators Association (OATIA) and The Ohio Department of Insurance Fraud Division join forces again to present this year s 2018 Ohio Joint Insurance Fraud Seminar. You will get to choose between different topic sessions. Please pay attention to the program schedule and registration when signing up for your classes. HISTORY OF ORGANIZATIONS: Established in 1997, the Ohio Chapter of NSPII is comprised of investigators, insurance claims personnel, attorneys, forensic experts, police, firefighters, educators and retirees dedicated to the further refinement of investigative ideas, procedures, techniques and professionalism through education and fellowship. Active in the fight against insurance fraud, the Ohio Chapter sponsors a full-day seminar and two educational meetings yearly to inform and encourage its members to strive toward the highest degree of expertise in the areas of insurance fraud recognition, prevention and investigation. With over a 100-year heritage, NICB is the nation s premier not-for-profit organization dedicated exclusively to fighting insurance fraud and vehicle theft. NICB was formed in 1992 from a merger between the National Automobile Theft Bureau (NATB) and the Insurance Crime Prevention Institute (ICPI). Since their founding, NICB has evolved dramatically into a results-driven 21st century organization. Today, their membership includes more than 1,100 commercial and personal line property/casualty insurers, workers compensation insurers, self-insured organizations, car rental companies, parking garages and public transit authorities. Beyond their membership, their 300+ employees work with law enforcement agencies, technology experts, government officials, prosecutors, international crime-fighting organizations and the public to meet their mission and deliver customer value. The Ohio Chapter of IASIU was founded in 1984 by a group of insurance industry fraud investigators. The International Association of Special Investigation Units (IASIU) is a non-profit organization dedicated to (1) promoting a coordinated effort within the industry to combat insurance fraud; (2) providing education and training for insurance investigators; (3) developing a greater awareness of the insurance fraud problem; (4) encouraging high professional standards of conduct among insurance investigators; and (5) supporting legislation that acts as a deterrent to the crime of insurance fraud. The Ohio Auto Theft Investigators Association (OATIA) officially started in 1981 when a group of law enforcement officers and insurance company investigators organized to provide an association for those professionals who investigate auto theft related crimes and insurance claims. The organization s goal is to provide free or low cost professional training and enhance communication efforts between all members. Our officers and board of directors are elected every two years by our active membership and are professionals from all areas of the auto theft investigation field. Membership in the organization is limited to those professionals in the field of auto theft investigation and prevention. OATIA s most effective weapon to combat the crime of auto theft is cooperation and training, including participation with the International Association of Auto Theft Investigators. Through seminars, meetings, and outreach, OATIA s members receive training and resources that are on the cutting edge of technology. Trends in auto theft are reviewed on local and statewide impacts. Through meetings like these, members become acquainted with each other around the State of Ohio and our border states resulting in case solutions and prosecution. OATIA provides a forum for members to pool resources in order to achieve our common interests and better serve our communities. The Ohio Department of Insurance Fraud Division is a criminal justice agency charged with conducting investigations into suspected insurance fraud and other crimes involving insurance. The Fraud Division has state-wide investigative authority and frequently works with law enforcement and prosecutors from all levels of government. On a yearly basis, the Fraud Division receives over 4,000 complaints and initiates over 200 criminal investigations. While the majority of the complaints received at the Fraud Division come from insurance companies, referrals are also received from law enforcement and other state regulatory agencies as well as from members of the general public. The majority of Fraud Division investigations involve staged accidents, inflated claims, arson for profit, agent theft, and billing for services not rendered by health care providers. CONTINUING EDUCATION: The following accreditations have been applied for: CFI, CLE in Kentucky and Ohio, CPCU, IAAI.

3 SEMINAR PROGRAM: 7:00 a.m. 8:00 a.m. Breakfast and Registration 7:30 a.m. 7:50 a.m. Welcome 8:00 a.m. 9:45 a.m. Topics 1, 2, 3 9:45 a.m. 10:00 a.m. Break 10:00 a.m. 11:45 a.m. Topics 1, 4, 5 12:00 p.m. 12:45 p.m. Lunch 1:00 p.m. 2:45 p.m. Topics 6, 7, 8 2:45 p.m. 3:00 p.m. Break 3:00 p.m. 4:45 p.m. Topics 9, 10 Topic 1: Is Insurance Fraud Still Relevant? Time: 8:00-9:45 a.m. repeats from 10:00-11:45 a.m. Matthew J. Smith, Esq. Coalition Against Insurance Fraud Washington, D.C. Why should we care about insurance fraud? It s a victimless crime, only the rich insurance companies pay and even insurers just underwrite the extra expense right? WRONG! Insurance fraud costs not only our nation $80 billion every year, but also takes innocent lives; and especially in this era of budget-cutting insurers and consumers need to wake-up to the costs and damage which come with insurance fraud. This program not only addresses those facts but also how a changing America views insurance fraud issues. We are a melting pot of generations ranging from Baby Boomers to Millennials and statistics show these generations have staggeringly different views of insurance fraud most of which do not bode well for the future. But what if we could change how America views insurance fraud, from inevitable or acceptable to something the public is united against? Impossible you say? Maybe not, this program also looks at how American culture and opinion on other, and more controversial issues, has been changed in the public eye. Can we do the same in the battle against insurance fraud? Topic 2: Vehicle Fire, Theft and Recovery Investigations Time: 8:00-9:45 a.m. This topic will cover a comprehensive in-depth analysis of stolen and recovered burned vehicles. The topic will include fire origin and cause examination, debris archeology, preliminary mechanical evaluations through fluid sample analysis, evidence issues, and ignition system evaluation. Also covered in this topic will be the importance of forensic evaluation of transponder anti-theft systems and keyless (smart key) technology in fire related scenarios. Dan Rottmueller Fire & Explosion Consultants LLC Dayton, OH Mark Ames A-1 Forensic Lock Service Toledo, OH

4 Topic 3: Overview of Medical Fraud Trends in Ohio Time: 8:00-9:45 a.m. This presentation will address local trends regarding medical fraud across property and casualty lines. Providing recent medical questionable claims data to identify specific snapshots of medical fraud activity in Ohio and it s comparison to National trends. Ingrid Squire, Special Agent National Insurance Crime Bureau Chardon, OH Break: 9:45 10:00 a.m. Topic 4: Legal Panel Q & A Time: 10:00-11:45 a.m. We will discuss the most recent legal developments involving SIU and claims, then answer questions from the audience regarding issues they are facing in their claims. Free legal advice! M. Tyler Hull, Esq. (Moderator) Smith, Rolfes & Skavdahl Co., LP.A. Cincinnati, OH Christine Farmer, Esq. Young & Alexander Co., L.P.A. Dayton, OH Catherine E. Robinson, Esq. Curtin & Curtin, LLP Akron, OH Todd Zimmerman, Esq. Rohrbachers Cron Manahan Trimble & Zimmerman Co., L.P.A. Dublin, OH Topic 5: Health Care Fraud Enforcement In Government Funded Programs Time: 10:00-11:45 a.m. During this discussion, panelists will explore the various models by which the state and federal governments deliver health care benefits, and discuss select program integrity efforts associated with each, highlighting the criminal jurisdiction of their respective agencies. The panelists will identify common fraud schemes and discuss emerging trends in provider fraud. Additionally, the panelists will explore enforcement tools and techniques, joint enforcement initiatives, and highlight recent enforcement successes. Lloyd S. Early (Moderator) Special Agent-in-Charge Ohio Attorney General Medicaid Fraud Control Unit Columbus, OH Nathan Cummings Assistant Special Agent-in-Charge Special Investigations Department Ohio Bureau of Workers Compensation Cincinnati, OH Brett Schwelgin Financial Crimes Supervisor Federal Bureau of Investigation Cincinnati, OH Verne Waldow Assistant Special Agent-in-Charge U.S. Department of Health & Human Services/OIG Office of Investigations Cleveland, OH

5 Lunch: 12:00-12:45 p.m. Topic 6: Current Vehicle Theft & Fraud Trends Time: 1:00-2:45 p.m. Class will cover current trends to include: cloned vehicles, classic car fraud & theft, VIN flips, title fraud and trailer thefts. We will discuss and provide examples of how to immediately recognize problems with a questionable vehicle or VIN. Additionally, instructors will cover basic VIN information on trucks, cars, ATV s, boats, trailers and construction equipment. We will also discuss the resources available to assist attendees in identifying questionable vehicles. Rick Munk, Special Agent National Insurance Crime Bureau Marysville, OH Trooper Dan Brown Ohio State Highway Patrol Vehicle Theft & Fraud Unit West Chester, OH Topic 7: Beyond the Numbers: Reviewing Financial Documents and Identifying Altered Documents Time: 1:00-2:45 p.m. Oftentimes, while insurance carriers are investigating a questionable loss, financial documents are requested from the insured. Obtaining the documents is the easy part; understanding and deciphering the documents can be tricky. We want to show you how to pull out the information needed from a sometimes overwhelming amount of documentation and how to make sense of the information. We will also discuss how to identify potentially fraudulent and altered documents, such as invoices, receipts, and other items submitted by an insured or claimant. Candace E. Padgett, CFE, FCLS Safe Auto Insurance Company Columbus, OH Robert D. Vaccari, CPA, CFE Johnson, Cambra & Sherwood, Inc. Loveland, OH

6 Topic 8: Insurance Fraud Legislation - A State and National Perspective Time: 1:00-2:45 p.m. This session will feature information on anti-fraud legislation in Ohio and the current political/legislative environment at the Statehouse. National perspective will be given from the NICB on what fraud trends they are seeing in Ohio and anti-fraud legislation in other states. The impact that state trade groups and companies can have on the legislative process will also be discussed. Michael D. Farley, Esq. (Moderator) Vice President, Legal & Government Affairs Ohio Insurance Institute Columbus, OH Timothy J. Lynch Government Affairs Director National Insurance Crime Bureau Des Plaines, IL Diane Chapman Government & Industry Affairs Manager Farmers Insurance Westerville, OH Break: 2:45 3:00 p.m. Topic 9: Fraud Reporting & The Most Common Elements That Lead To A Criminal Prosecution Time: 3:00-4:45 p.m. State fraud bureaus strive to prosecute those who commit insurance fraud and a quality fraud referral could be the first step in a criminal investigation being initiated by a state department of insurance. Join Michelle Rafeld, Assistant Director of Fraud & Enforcement for the Ohio Department of Insurance, as she discusses the elements of a quality fraud referral, reporting issues identified by state fraud directors, expectations of state regulators, and factors that most often lead to a successful criminal prosecution. Michelle Rafeld, Assistant Director Ohio Department of Insurance Columbus, OH Topic 10: Emerging Trends in Insurance Fraud Fires Time: 3:00-4:45 p.m. This presentation will cover the emerging trends encountered by fire/arson investigators across Ohio within the last 5 years. Topics will also include the potential reasons that the trends have developed and how the internet has played a significant role. Joshua P. Hobbs, Bureau Chief State Fire Marshal Fire & Explosion Investigations Bureau Reynoldsburg, OH

7 Registration Form For each session, please indicate on the line next to the Topic # your 1st and 2nd choices for each session by placing a 1 or 2 on the line. (8:00 a.m. 9:45 a.m.) Morning 1st Session: Topic #1: Topic #2: Topic #3: (10:00 a.m. 11:45 a.m.) Morning 2nd Session: Topic #1: Topic #4: Topic #5: (1:00 p.m. 2:45 p.m.) Afternoon 1st Session: Topic #6: Topic #7: Topic #8: (3:00 p.m. 4:45 p.m.) Afternoon 2nd Session: Topic #9: Topic #10: Lunch: Yes No Name (Please Print or Type) Address Company Address City State Zip Telephone NSPII IASIU NICB OATIA The OH Dept. Ins. Fraud Div. Non-Member Enclosed is my check for: $ Member of NSPII, IASIU, NICB, OATIA $ Non-Member $50.00 Public Sector Investigator/Law Enforcement REGISTRATION DEADLINE: FEBRUARY 23, NO REFUNDS ISSUED AFTER THIS DATE. NOTE: ALL REGISTRATIONS MAILED OR RECEIVED AFTER FEBRUARY 23, 2018 MUST ADD A $25.00 LATE FEE TO THE REGISTRATION FEE. Make Seminar registration checks payable to NSPII. Mail check and Registration Form to: Mary Beth Robinson, NSPII, P.O. Box 88, Delaware, OH If paying by credit card, fill out the table below and fax ( ) or (nspii@nspii.com) it to the attention of Mary Beth Robinson, NSPII. Cardholder Name: Account Number: Card Type: Visa / MC Expiration Date: CVV/CVC (3 digit # on back of card): Cardholder s Billing Address w/zip code: Signature: Inquiries: Mary Beth Robinson ( ).

8 Mary Beth Robinson NSPII P.O. Box 88 Delaware, OH PRESORTED STANDARD US POSTAGE PAID COLUMBUS, OH Permit No Presented By: NSPII-Ohio Chapter, NICB, Ohio Chapter of IASIU, OATIA, The Ohio Department of Insurance Fraud Division