CSI: A Secure Solution For Insurance Fraud Investigations

CSI: A Secure Solution For Insurance Fraud Investigations

Founded in 2001 by Chris Cavallo, CSI is a multi-level investigation company that handles the investigations of numerous cases through the use of various investigative methodologies. For many years the company has been known for helping clients in discovering hidden assets, witness locations/interviews, Comprehensive Background/Social Media investigations and most importantly, fighting illegitimate insurance fraud claims to name a few.

Insurance fraud refers to any act committed with the intention of defrauding a business and/or an insurance company. Cases of insurance fraud occur when a person tries to acquire benefits to which they are not entitled or when an insurance company deliberately refuses to issue due benefits.

The most common of these frauds are often related to healthcare, worker compensation, automobile accidents, and diversion of assets. Many of the claims received by insurance companies annually are fraudulent claims. These are claims that are filed for the sole purpose of defrauding a company. Annually, claims such as this pay-out an estimated eighty billion dollars.

Insurance Fraud Classifications

There are two major classifications of insurance crimes: the soft and the hard levels. The “soft level” is the commonest of these two classifications.

Soft level

This level typically involves making dishonest, exaggerated claims. In this type of fraud, the claims are legitimate but exaggerated to gain more money. Individuals who make these claims are primarily seeking profit from a loss. For instance, an individual whose insured house accidentally was in lets say a kitchen fire might decide to claim more than the actual damage.

Hard level

In the example given above, the accidental burning of the house is a legitimate hazard. However, if the claimant intentionally sets the house on fire, then this is considered illegitimate. This is an extreme level categorized as deliberately causing harm, accidents, or faking death to acquire benefits.

Types of insurance fraud.

There are four major types of insurance fraud, ranging from health, organizational, automobile, and so on. Each of these would be listed below for better understanding.

Worker’s Compensation

For factory workers and employers, the issue of compensation is very often seen in the courtroom. It is commonly believed that worker compensation fraud occurs many times when employers lie or fail to pay the necessary dues to their workers. However, this is not always the case.

There are various instances of employees making misleading claims of injury for the sole purpose of extorting cash from their employers. In cases like this, proper investigation is required to avoid the occurrence of fraud.

Over the years, CSI has handled cases such as these. Factory workers may attempt to scam their employers by reporting an injury that had no witnesses, file an injury that occurred outside the workplace, refused or deliberately delay getting clinical help, claim non-existent injuries, or report an injury after being laid off.

Through the implementation of various investigative tools, CSI Secure Solutions investigates cases against companies who engage in fraudulent activities against their workers, by either denying legitimate cases of injury, deliberately refusing to purchase insurance for staff members, or issuing fake policies.

Healthcare

This type of insurance fraud is further divided into provider fraud and insured person fraud. The most common perpetrators of this act are healthcare providers.

Provider fraud occurs when a provider makes bogus claims, bills for services that were never administered, presents expensive treatment plans which do not fall within the patient’s scope, or offers services with a revoked medical license.

Insured person fraud occurs when a person makes claims for ineligible people, hides existing health conditions, fails to register other coverage, lies about information provided on the enrolment form, and fails to reveal injuries that occurred at the workplace.

Health insurance firms also participate largely in insurance fraud. They do this by the deliberate refusal to pay claims, denial, and cancellation of coverage, and underpayment of health care providers.

CSI Secure Solutions assist in minimizing this type of insurance fraud by carrying out in-depth research and investigations to ensure that the perpetrators of these acts are brought to justice. The company collaborates with state and federal law enforcement agencies to identify and prevent health care fraud.

Automobile

The extreme cases of automobile fraud occur when people intentionally cause their accidents. Less extreme cases occur when accidents happen naturally, and claimants make exaggerated claims on the actual damage done.

In cases of staged collisions, claimants might deliberately run into a car, drive carelessly, jump out of a car, jump in front of an expensive car, or cut the brakes of their car. This type of fraud does not just affect the claimant but also the innocent person who was involved in the accident.

 

Occupational

Known as business or organizational fraud, the sum of this type of fraud in 2018 alone was over $7.1 billion. Occupational fraud comprises asset misappropriation, bribery, economic extortion, and illegal gratuities.

It is mostly perpetrated by an organizational CFO (Chief Financial Officer). This is an individual tasked with the responsibility of managing the company’s funds.

Their duties include record keeping, financial planning, and reporting, as well as managing financial risks.

The most common kind of occupational fraud is asset misappropriation. If properly investigated, CFOs or anyone in charge of assets will be found guilty of charging personal expenses to their companies, tampering with checks, recording extra charges, and issuing expensive reimbursements, amongst other crimes.

Through thorough investigative processes involving a lot of hard work, CSI Secure Solutions has worked to ensure that these fraudulent crimes are stopped. By observing, interviewing, and recording research, they generate proof of money laundering within corporate institutions.

Conclusion

With access to the best possible sets of databases, CSI Secure Solutions has over the past twenty years helped companies and individuals uncover relevant investigative information which is only accessible to authorized experts and law enforcers.

Recently CSI Secure Solutions announced the addition of NY based Mike Connolly as an Investigative Consultant to the Insurance Fraud division. Chris Cavallo stated that “Mike introduced me to the Security/Investigations Industry some 40 +yrs. ago and was my mentor and primary reason for my successes in the industry and I feel honored to have him on board with the company. Mike will be making direct contact with Business owners, Insurance Carriers, Claims Adjusters and Insurance Défense firms to let them know that “Help is on the Way” in the form of various service offerings for any and all types of illegitimate claims regarding Insurance Fraud ”.

If you would like more information on Insurance Fraud services please contact Mike Connolly directly at Mike@csi-securesolutions.com or (917) 791-2769

CSI Secure Solutions is a nationwide Investigations company with service offerings in over 40 + states specializing in Insurance Fraud, Hidden Assets , Witness location/interviews, Comprehensive Background investigations inclusive of Social Media, OSINT Research as well as complex surveillance operations from border to border.

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