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Who should attend Insurance Fraud Investigation: 2-Day Workshop
Professions in insurance industry: CEOs, CFOs, COOs, Claims adjustors, Managers and staff, Supervisors, Personnel responsible for issuing or approving insurance policies or claims. Accounting professionals
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Professions in insurance industry: CEOs, CFOs, COOs, Claims adjustors, Managers and staff, Supervisors, Personnel responsible for issuing or approving insurance policies or claims. Accounting professionals

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Seminar Summary:

Participants will have the opportunity to review the red flags that could be an indicator of insurance fraud. The procedures for conducting an insurance fraud investigation will be discussed and the legal issues will be examined. (see full course description)

 
 
 

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Training Course Syllabus:


Insurance Fraud Investigation: 2-Day Workshop

By:Robert Minniti, President and Owner of Minniti CPA, LLC

Course Description:

This course will cover the issues associated with insurance fraud. Examples of various types of insurance fraud, including application frauds and claims frauds will be presented. We will also discuss frauds committed by insurance agents and companies. Participants will have the opportunity to review the red flags that could be an indicator of insurance fraud. The procedures for conducting an insurance fraud investigation will be discussed and the legal issues will be examined. We will discuss strategies for preparing both civil and criminal insurance fraud cases. We will also discuss internal controls and procedures that could help to prevent or detect insurance fraud. We will review federal and state insurance fraud laws. Case studies will be presented to allow the participants to practice the skills learned in the seminar.


Learning Objectives:

Understanding the basics of insurance fraud
Application Fraud
Claims Fraud
Agent Fraud
Identifying Red flags that could indicate insurance fraud
Conducting Fraud Investigations
Preparing for a civil case
Preparing for a criminal case
Designing internal controls to prevent and detect insurance fraud

Areas Covered in the Seminar:

Internal controls designed to prevent insurance fraud
Internal controls designed to detect insurance fraud
Insurance application fraud
Insurance agent fraud
Insurance claims fraud
Insurance fraud investigations for civil and criminal cases
Legal issues in insurance fraud investigations
The red flags that could indicate insurance fraud
Federal and state insurance fraud laws

Course Outline:
Day 1 (8:30 AM – 4:30 PM)


8:30 – 9:00 AM: Registration
9:00 AM: Session Start Time

The Overview of Insurance Fraud
The definition of fraud
Civil definition of fraud
Criminal definition of fraud
The fraud triangle
The elements of fraud
To sustain a claim of fraud, insurer was required to plead and prove each of the nine elements of fraud: (1) a representation; (2) falsity of the representation; (3) materiality of the representation; (4) speaker’s knowledge of the falsity of the representation; (5) the speaker’s intent it should be relied upon; (6) the hearer’s ignorance of the falsity of the representation; (7) the hearer’s reliance on the representation; (8) the hearer’s right to rely on the representation; and (9) the hearer’s consequent and proximate injury caused by reliance on the representation.
Why people commit fraud
Types of insurance fraud
Insurance application frauds
When a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due. According to the United States Federal Bureau of Investigation the most common schemes include: Premium Diversion, Fee Churning, Asset Diversion, and Workers Compensation Fraud. The perpetrators in these schemes can be both insurance company employees, insurance agents and claimants
Insurance claims frauds
Insurance agent frauds
Ways insurance agents can misappropriate funds:
Lapping
Skimming
Fictitious Policies
Forgery
Churning
False Claims
False applications
The red flags that could be indicators of insurance fraud
Designing internal controls to help prevent insurance fraud
Designing internal controls to help detect insurance fraud
California insurance laws and regulations

Day 2 (8:30 AM – 4:30 PM)


Insurance fraud investigations
Starting an insurance fraud investigation
Interviewing techniques
Legal systems
Multi-media research
Surveillance equipment and methods
Crime scene investigation
Supervising an insurance fraud investigation
Managing insurance fraud investigations
Legal issues in insurance fraud investigations
Introduction
Evidence of Other Incidents
Hearsay
Using Experts in Fraud Cases
Discovery and Privilege
Constitutional Issues
Criminal Proceedings
Investigating a civil insurance fraud case
Working with private investigators
Working with fraud investigators
Working with attorneys
Introduction
The Policy as Contract
Parties to the Insurance Contract
Insurer´s Duties
Policy Conditions
Remedies
Criminal Actions
Investigating a criminal insurance fraud case
Working with law enforcement
Working with prosecutors
Considering settlements
Alternative dispute resolution methods

Seminar Summary:

Participants will have the opportunity to review the red flags that could be an indicator of insurance fraud. The procedures for conducting an insurance fraud investigation will be discussed and the legal issues will be examined. (see full course description)

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