Insurance Fraud Enforcement Department. Referrals Process. Standard Operating Procedure (SOP)

Transcription

1 Insurance Fraud Enforcement Department (IFED) Referrals Process Standard Operating Procedure (SOP) Reference Information Responsibilities Name of SOP author: D/Supt. Robert Wishart Unit or Department: Insurance Fraud Enforcement Department Directorate owning this SOP: Economic Crime Directorate Version control Date of latest version: December 7,

2 1. Introduction This document complements existing Standing Operating Procedures (SOPs) operated by the Economic Crime Directorate (ECD). It describes how cases submitted to the Insurance Fraud Enforcement Department (IFED) will be considered for investigation, and how a case acceptance matrix (see page 6) will be used in this process. IFED s referral process seeks to be transparent and auditable. It offers clear guidance to those considering the submission of a suspected crime for investigation and the quality of submission required. It also aims to provide reassurance to the ABI s membership that the process is fair and that cases accepted for investigation reflect the vision and strategic priorities of IFED. The case acceptance process follows the premise that cases accepted for investigation accord with the control strategy priorities highlighted by IFED s strategic threat assessment. In summary, the investigations made by the unit will reflect the current threat faced by the insurance industry; however, this will not preclude the acceptance of cases that sit outside control strategy priorities when extraordinary circumstances prevail. Crime recording processes that are linked to Home Office Counting Rules (HOCR) and National Crime Recording Standards (NCRS) are covered within a separate SOP held by ECD. Additionally, the process for allocating investigations to the Association of Chief Police Officers (ACPO) forces is considered within an ACPO doctrine. Given the breadth of current fraud reporting, and allied to the demands placed upon the finite investigative resources within the unit, it is imperative that any decision as to whether or not cases are accepted for investigation are made consistently and transparently. 2

3 2. How to make a referral 2.1 Direct referral When industry suspects criminal activity which includes one of the key areas identified in IFED s strategic threat assessment, a direct referral should be made to IFED. Direct referral will be the primary route for insurers referrals. Industry s designated Single Points of Contact (SPOCs) will complete the referral form (see template on page 7) and send it to IFED along with any evidential package. Referrals should be ed to: Referrals should be faxed to: Referrals should be delivered to: ifedreferrals@cityoflondonpolice.uk Insurance Fraud Enforcement Department 21 New Street London EC2M 4TP When it is not possible to attach the evidential package to an , it may be delivered to the above address. 2.2 Insurance Fraud Bureau referral The Insurance Fraud Bureau (IFB) provides a unique function in identifying viable targets for investigation by IFED, and those Organised Crime Groups which are targeting the insurance industry across a number of companies. The IFB also receives information from the insurance industry Cheat Line which provides possible lines of enquiry and opportunities for police enforcement. The IFB will complete the referral form and attach the evidential package. 2.3 Urgent referrals Such is the nature of crime that there will be occasions when requests for urgent police action will be sent to IFED. ECD operates a 24/7 service for the victims of fraud crime whereby the Duty Fraud Inspector can be contacted. Requests for immediate assistance are not limited to but include those when: Funds are at risk Suspects may have been alerted and may attempt to flee the jurisdiction Evidence is likely to be lost or destroyed Further harm to the victim company is imminent Between the hours of 8:00 am to 6:00 pm, IFED can be contacted direct on During these hours an initial call relating to an insurance fraud related crime will be relayed to the IFED Duty Team for immediate assessment. Outside these core hours, the ECD Duty Fraud Squad Inspector can be contacted on The Duty Detective Inspector will assess the referral and decide if immediate police action is required and contact an IFED officer as necessary. 3

4 Table 1 Key areas of assessment and examination in IFED s referral process Assessment Examination 1 Is it a fraud crime? Does the information constitute a fraud crime in law and when there is no credible evidence to the contrary? 2 Locality of the offence What jurisdiction does the case fall under, i.e. who is the most suitable organisation or Law Enforcement Agency to conduct the investigation? (This is determined by the HOCR rules) 3 Are there any viable lines of enquiry? 4 Is there a requirement for immediate action or any risk of loss to evidence? 5 Is there any significant harm or risk? Do the investigative leads exist to enable an investigation to take place? Of the investigative leads available, is there a requirement for immediate action to secure evidence? Does the crime pose any significant harm, risk or threat, be it monetary, political, financial or otherwise? 3. Detailed assessment The next stage involves an in-depth assessment carried out by the Detective Chief Inspector or Detective Inspector of IFED. The assessment will address those areas detailed in table two below. Effective assessment will require further intelligence-gathering by the crime reviewer to establish: 1. The provenance of the referral s facts 2. The validity of the information and evidence available 3. The potential investigative strategy and requirements The parameters applied to the initial assessment remain fluid and in exceptional cases are set by the Head of IFED. However, in general the parameters will be the above three points. The stage of detailed assessment should be restricted to initial research and the identification of what operational action is required. During detailed assessment, the allegation will be recorded on UNIFI (the City of London Police Crime Recording System) as a fraud investigation (as per the current Action Fraud scheme). 4

5 Table 2 Areas of assessment explained Assessment Explanation 1 Control strategy The priority areas for the National Fraud Insurance Bureau (NFIB). 2 Intelligence requirement The intelligence gaps that the NFIB are seeking to fulfil. 3 Enquiry matrix The assessment matrix which determines the priority of the referral and provides a numbered score; a threshold score is applied to assist the decision making process. 4 City crime If the case falls within the jurisdiction of the City of London. 5 Existing investigations Whether any criminal or civil investigations have been made or are ongoing, and what the impact of any investigations is on the referral. Following these areas of assessment, the information is considered and scored against IFED s scoring matrix by the unit s Detective Inspector. (A copy of the matrix can be found in Appendix B). The matrix threshold is set against the availability of resources. If accepted, the investigation will be allocated to an officer for investigation. 4. Oversight The Detective Chief Superintendent of ECD (or his nominee) will ensure that victims or referring third parties are informed by letter within 28 days if a case has not been accepted for investigation by IFED. The letter will outline the details of the review and the rationale for the decision. It is acknowledged that on occasions, a referrer may be dissatisfied with the decision made by IFED and formal representation may be made. Such representations will be considered for review when supported by new evidence previously undisclosed to those officers reviewing the referral. An individual s statutory rights or entitlement to make a complaint against the Police to the Professional Standards Unit of the Independent Police Complaints Commission (IPCC) will not be affected by reverting to IFED s formal appeals procedure. 5

6 Appendix A triage process Risk Is there any risk to personal safety, property etc. If so, is any immediate action required to avert or mitigate the risk? Harm Is there risk of any harm to a community or potential risk for harm/community harm. If so, is any immediate action required to mitigate that risk. Harm What is the capacity of the network to commit harm? Does the network indicate significant risk to the public, organisation, business sector or the UK economy? Community impact Does the network impact on any particular community; what is the perceived result of that impact? What are the short and long term implications? Money at risk Is there a requirement to secure any money at risk: consider restraint. Organised crime Does the network contain organised crime groups, are there links to other forms of criminality? Is the network level 1, 2 or 3? Opportunities under the Proceeds of Crime Act Are there any opportunities for restraint, forfeiture or confiscation? Vulnerable persons Are there any vulnerable persons within the networks; is any immediate action required? What is the impact on those persons? Will they require specialist support? Are they vulnerable to be a repeat victim? Control strategy or intelligence requirement Does the network fall within the NFIB intelligence requirements or control strategy areas? 6