The fight against Insurance Fraud in South Africa also discussed at European Seminar

Hugo van Zyl the COO of the SAICB was invited to and presented a paper on the prevalence of insurance fraud from a South African perspective at the IASIU EUROPE 2012 SEMINAR in Dresden, Germany. This event took place from the 4 to the 6 May 2012 in the town of Dresden in the South of the Old East Germany.

The International Association of Special Investigation Units (IASIU) was founded in 1984 by a group of Insurance Industry Fraud Investigators (www.iasiu.org)

IASIU Mission

Founded in 1984 by a group of insurance industry fraud investigators, the International Association of Special Investigation Units (IASIU) is a non-profit organization dedicated to:

  • Promoting a coordinated effort within the industry to combat insurance fraud;
  • Providing education and training for insurance investigators;
  • Developing greater awareness of the insurance fraud problem;
  • Encouraging high professional standards of conduct among insurance investigators;
  • Supporting legislation that acts as a deterrent to the crime of insurance fraud

IASIU MEMBERSHIP: MEETING WITH INTERNATIONAL BOARD

IASIU Membership

IASIU membership is made up of more than 4,000 individuals representing more than 600 insurance and self-insured companies around the world. Regular membership is limited to employees of insurance or self-insured special investigation units, special agents or supervisors of the National Insurance Crime Bureau or Insurance Crime Prevention Bureau. Associate membership is open to insurance company personnel who support the investigative process and the law enforcement community involved

In addition to membership in IASIU, chapters exist throughout the United States, Canada and Europe to enable IASIU members to better address industry issues. Currently, IASIU recognizes more than 40 chapters that adhere to IASIU guidelines and hold regular meetings and training seminars. Members of the chapters must first hold IASIU membership. For more details, contact IASIU headquarters.

A total of 187 IASIU members from 70 Insurance companies and 28 countries attended the seminar.

European Insurance companies in attendance were:

  • Zurich Insurance
  • Lansforsakring
  • Lloyds of London
  • Top Danmark
  • Chartis
  • General Reinsurance
  • Generali
  • Metlife

The following Fraud Bureaus and Insurance Associations attended the seminar:

  • Danish Insurance Association
  • Larmjanst (Sweden)
  • Czech Insurance Association
  • Federation of Finnish Financial Services
  • National Insurance Crime Bureau (NICB) United States of America
  • Foundation for Tracking Vehicle Crime and Crimes to (Netherlands)

On the morning of 4 May Lars Skaar the European IASIU President opened the seminar and informed the attendees that Europe is proud to launch their brand new certification of Insurance Fraud Investigators.

Hugo van Zyl presented on the first day with regards to the Insurance Fraud situation in SA. It was quite clear that Vehicle crime is an international problem, and more so the cloning of vehicles. Furthermore the cross border vehicle crime and the problem to repatriate vehicles were discussed in depth. It was abundantly clear that the rest of the world experienced the same problems as we do here in SA.

Emphasis was placed on all types of medical fraud which seemed to be the most prevalent problem in Europe and the United States.

Joe Wehrle the President/CEO of the NICB presented on the wide spread incidence of Staged Accidents and Medical Fraud. He said that the NICB has taken action and lead a united front to combat Insurance crimes with emphasis on medical fraud. He informed the audience that there were 370 staff members of which 170 were investigators and more than 50 comprised of analysts.

He stated that more than 40 000 people within the industry and Police were trained annually. Several task forces have been established in the States to address the problems experienced in several of the states.

The focus of the NICB is on data analytics, investigations, training, legislative advocacy and public awareness whist prioritising Medical Fraud, Commercial fraud and Vehicle Fraud.

In one of the organised crime medical schemes 36 individuals, including 10 doctors, 3 lawyers, 2 chiropractors, 2 acupuncturists, and a physical therapist were involved with the remaining individuals emanating from an Eastern Europe Mafia group. They have defrauded the medical industry to the tune of $300 million. The working methodology of these crime rings will be shared with the membership of the SAICB.

He made the following recommendations to address fraud based on proven successes experienced in the United States:

1. Appropriate laws, regulations, and resources are needed to address staged collisions and associated service provider fraud

2. Create a single integrated ¡§all claims¡¨ database to improve fraud detection

3. Support the mandatory reporting of suspect claims to a law enforcement agency or investigative body

4. Emphasize importance to identify questionable claims

5. Recognize the value of claim scoring/predictive modelling with the ability to confirm results

6. Immunity protection for individuals and organizations that provide information or otherwise cooperate with fraud investigations

7. Fund dedicated prosecutors and fraud prosecution bureaus at the appropriate jurisdictional levels

8. Use ¡§Task Force¡¨ approach to share information: Law Enforcement, Insurers, Anti Fraud organizations during routine, automated, and electronic submissions

9. Public Awareness ¡V Immigrants are targeted and recruited into Organized Group schemes ¡V efforts should be implemented to protect them and educate the general public to identify fraud and its impact

10. Ability of insurers to suspend payments until investigation is completed where reasonable grounds supporting fraud exists

11. Regulations to control the ownership, operation and licensing of medical clinics

12. Strong and effective criminal penalties

13. Mandatory Anti-Fraud Training for Law Enforcement, Insurers and appropriate Associations

He concluded by saying that we must have a shared vision to combat Crime and Fraud.

The rest of the presenters concentrated on stake holder relationships, Cross Border cooperation, Medical fraud, Marine Cargo, Claims Fraud and Terrorism, Abuse of false Identity documents, etc.

At the end of the conference the newly elected president pleaded to the attendees to form a united front against Insurance Fraud and work towards a European Insurance Fraud Bureau.

[Info from South African Insurance Crime Bureau]

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