Confronting Organized Insurance-Fraud Schemes and Sham Claims
Avoiding Payment of Sham Claims, Tools to Deter and Recover from Scheme Leaders, Seeking Criminal Prosecution
Course Details
- smart_display Format
On-Demand
- signal_cellular_alt Difficulty Level
- work Practice Area
Insurance
- event Date
Wednesday, May 27, 2020
- schedule Time
1:00 p.m. ET./10:00 a.m. PT
- timer Program Length
90 minutes
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This 90-minute webinar is eligible in most states for 1.5 CLE credits.
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This CLE course will guide attorneys representing insurance companies in spotting and unraveling increasingly complex and organized fraud. These schemes may be related to only one claim but increasingly span multiple industries and types of policies, including commercial and property; life, health, disability; and third-party personal injury. The webinar will discuss “red flags” suggesting sham claims and offer aggressive strategies and practical techniques deterring fraud, recovering payments from the masterminds, dealing with State regulators, and whether to pursue criminal charges.
Ms. Perkins’ practice includes cybersecurity and privacy law, complex civil litigation, internal corporate investigations, insurance fraud and white-collar defense. Her experience in both the public sector and in private practice lends itself well to providing a seasoned and engaged focus on emerging and evolving cybersecurity threats to data security, privacy rights, data breach risk management and incident response. Ms. Perkins has successfully worked to resolve issues involving employee misconduct, institutional and corporate risk management and incident response, malfeasance and fraud, officer and board accountability and governance as well as federal and state grand jury investigations.
Mr. Spector is the co-chair of Holland & Knight's Insurance Fraud and Recovery Team. He is an accomplished first-chair trial lawyer who focuses his practice on the investigation and litigation of fraudulent schemes and unfair and deceptive practices. Mr. Spector's clients include property and casualty and health insurers, financial institutions, self-insured retailers and other market leaders operating in the United States.
Mr. Valdivia is a West Palm Beach litigation attorney who practices commercial and civil litigation. He focuses his practice in the area of fraud and recovery, litigating complex fraud schemes and unfair and deceptive practices on behalf of automobile and health insurers.
Insurance fraudsters now have advanced digital tools to make more difficult distinguishing the fraudulent claim from the valid one. Particularly concerning, perpetrators of fraud can now manipulate medical records, including x-rays and pet-scans, photographs and video, and metadata to produce convincing forgeries that are difficult to spot and prove.
Insurance fraud will usually focus on recovering high-value claims, such as from business interruption (data theft), jewelry theft, fire and water damage, inland marine, and other specialized property losses. But the “scams” are perennial: inventory swapping; submitting claims for injuries or damage that never occurred; staging accidents; forgery, involving unwitting third parties, and more.
To deter and thwart these increasingly complex and sophisticated deceptions that may cross multiple industries and involve different kinds of coverage, insurers and their counsel need practical, decisive, and effective weapons. At the same time, they must balance the need to avoid claims of bad faith, making false accusations, and comply with insurance regulations. How much information to provide prosecutors is always a challenging question. State immunity laws do not always cover allegations of insurance fraud.
Listen as the panel discusses proactive steps to identify fraud early on and then and prevent payment of the falsified claim, and if payment has occurred, how to judiciously but vigorously recover payment from the masterminds.
- Insurance fraud schemes involving property
- Inflated inventory
- Phony or inflated thefts
- Paper boats
- Arson for profit
- The "red flags" of insurance fraud
- The fraud examination with eye to litigation
- Pre-suit remedies to preserve assets
- Immunity laws
- Surveillance
- Making the case in court
The panel will review these and other significant matters:
- Red flags signaling fraud
- Finding the right experts to assist with a sophisticated fraud examination
- Using the right technology and the latest computer software to uncover "deep fakes"
- How to build the fraud case from the beginning to ensure the best result
- Dealing with immunity laws and responses from those being investigated
- Pre-trial remedies to preserve assets
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