Aggression has its rewards
No law enforcement agency likely has interrogated more insurance crooks — especially ring leaders — than the California fraud bureau. In a recent conversation with outgoing fraud bureau director Dale Banda, we asked what he had learned from these fraudsters.
These crooks are savvy and seek to exploit the weaknesses in the system, Dale revealed. They know which insurers investigate aggressively and which don’t.
I recalled Dale’s comments this week when the photo below showed up in my inbox. The photo shows a handmade sign in one of those New York City clinics that specialize in no-fault auto claims. It’s not like health insurance: This clinic isn’t announcing that it doesn’t have contracts with specific health insurers. It’s telling the world that it won’t deal with these insurers because they investigate fraud aggressively.
Such aggression cuts into the profits of sham clinics. If all insurers were as tough as these four, the clinic owners might have to find another line of work.
I asked one SIU director why he thinks his company made the list. His one-word answer: “consistency.”
“The clinics have to know that we will not change our approach on the next claim filed nor will we pay for anything but legitimate medical care,” said Ken Jones of Travelers Insurance. “When these suspect medical providers realize that insurance carriers are taking this type of stand, they tend to look for easier targets.”
Each of these four insurers should view this sleazy sign as a badge of honor.
And the other major auto insurers in New York should ask themselves what they need to do to make the list.
December 13th, 2008 at 10:59 am
The Florida Department of Financial Services, in my opinion, is one of the elites in fighting insurance fraud. Indeed, there are arguments among siu’ers and detectives sometimes but the truth of the mater is that the detectives always seek to take on new claims and referrals from siu’ers and I wanted to just state this because I very much appreciate Florida DIF and its members and once again I would like to re-iterate the fact that we may have some bickering at times but the bottom line remains, Florida DIF is always available to Florida SIU’ers and they continue to train hard on pip issues in Florida which is one of the larger issues we have in this state. My thanks to Florida DIF and its members.
John C. Oral, MA,CFE,FCLS