Preview of the Insurium Privacy Compliance CA Module 903
Available at:
"Lulu (www.lulu.com), the world's fastest-growing provider of print-on-demand books." or directly from Insurium at info@insurium.com

PRIVACY POLICY
Date of original issue:

Enter Date Here
INTRODUCTION
In 2000, the federal government of Canada enacted The Protection of Personal
Information and Electronic Documents Act ( "PIPEDA"). Effective January 1, 2004, all
organizations that collect, use or disclose personal information in the course of their
commercial activities will be subject to PIPEDA or substantially similar provincial
legislation such as; Personal Information Protection Act ("P.I.P.A") (collectively, "privacy legislation").
Briefly stated, privacy legislation requires that the consent of an individual be obtained
for the collection and use of his or her personal information, that steps be taken to
protect personal information and that one or more individuals be appointed to monitor
compliance with the provisions of applicable privacy legislation.
Your Company Name Here ("Your Company Name "Shortened" Here") is committed to controlling the collection, use and
disclosure of personal information provided by the customers and employees and have adopted this Privacy Policy to ensure the accuracy, confidentiality and integrity of such personal information.
APPLICATION
This Privacy Policy applies to personal information that (Your Company Name "Shortened" Here) collects, uses or discloses in respect of any of its customers or employees in the course of its commercial activities. It does not, however, apply in respect of the collection, use or disclosure of the following information :
• Information that is publicly available, such as a customer’s name, address, telephone number and electronic address, when listed in a directory or made available through directory assistance;
• The name, title, business address or telephone number of an employee of an organization that is publicly available.
The application of this Privacy Policy is subject to the requirements or provisions of any
applicable legislation, regulations, tariffs or agreements (such as collective agreements),
or the order of any court or other lawful authority. Various legal criteria independent of
this Privacy Policy will determine whether federal or provincial privacy legislation applies
to the personal information that Your Company Name "Shortened" Here collects, uses or discloses in respect of its customers or employees.
This Privacy Policy does not replace those criteria and nothing in this Privacy Policy should be construed as indicating which privacy legislation, if any, applies to the collection, use and disclosure of personal information.
DEFINITIONS
The following defined terms are used throughout this Privacy Policy:
Your Company Name "Shortened" Here – means Your Company Name Here Inc.
Collection – means the act of gathering, acquiring, recording or obtaining personal information from any source, including third parties, by any means.
Consent – means voluntary agreement with the collection, use and disclosure of personal information for defined purposes. Consent can be either express or implied and can be provided directly by the individual or by an authorized representative. Express consent can be given orally, electronically or in writing but is always unequivocal and does not require an inference on the part of Your Company Name "Shortened" Here. Implied consent is consent that can reasonably be inferred from an individual’s action or inaction.
Customer – means an individual who:
(a) subscribes for, uses, or applies to use, the products or services of (Your Company Name "Shortened" Here);
(b) corresponds with a (Your Company Name "Shortened" Here); or
(c) enters into a contractual agreement with (Your Company Name "Shortened" Here).
Disclosure – means making personal information available to (Your Company Name "Shortened" Here’s) employees, contractors, or third parties outside of (Your Company Name "Shortened" Here).
Employee – means an employee, former employee or pensioner of a (Your Company Name "Shortened" Here) and, for the purposes of this Privacy Policy, includes the directors,
shareholders and security holders of (Your Company Name "Shortened" Here).
Personal information – means information about an identifiable individual recorded in
any form and includes, but is not limited to, such things as race, ethnic origin, nationality, colour, age, gender, marital status, religion, education, medical information, criminal
information, performance reviews, trade union membership, employment and financial
history, income, address and telephone number, e-mail address, numerical identifiers
such as Social Insurance Number, and views and personal opinions. Personal information also includes information about a customer’s product and service subscriptions and usage, credit information, billing records, service and any recorded complaints and, in the case of an employee, includes information found in personal employment files, performance appraisals and medical and benefits information. Publicly available information, such as a public directory listing of names, addresses, telephone numbers and electronic addresses, however, is not considered personal information.






Privacy legislation – means The Personal Information Protection and Electronic
Documents Act (Canada) and/or substantially similar provincial legislation.
Third party – means an individual other than the customer/employee or his or her agent
or an organization other than (Your Company Name "Shortened" Here).
Use – means the treatment, handling and management of personal information by the
(Your Company Name "Shortened" Here).
THE TEN PRIVACY PRINCIPLES
This Privacy Policy has been developed in accordance with the standards set out in
PIPEDA, PIPA and is modeled after the Insurium Corporate Achievement Training and Education, Model Code for the Protection of Personal Information, CA Module 903 (the "Insurium Code"). Accordingly, the ten principles of fair information practices, as identified by the Insurium Standard, have been adopted by Your Company Name Here represent a formal
statement of the minimum requirements to be adhered to by (Your Company Name "Shortened" Here) for the protection of personal information collected from the customers and employees of (Your Company Name "Shortened" Here).

Preview of the Insurium Privacy Compliance CA Module 903
Available at: "Lulu (www.lulu.com), the world's fastest-growing provider of print-on-demand books." or directly from Insurium at; info@insurium.com

Build your Business with Integrity and Protect the Confidential Information Entrusted to you.


By Martin Maylor,
Business Responsibility and Compliance Consultant
Insurium Inc.
www.insurium.com

Who steals my purse steals trash; tis something, nothing; twas mine, tis his, and has been the slave to thousands; but he that filches from me my good name robs me of that, which not enriches him, and makes me poor indeed. - William Shakespear, Orthello –

The right to privacy is a fundamental value in all democratic societies (1). Article 12 of The Universal Declaration of Human Rights, adopted by the General Assembly of the United Nations (2), and the Canadian and Quebec charters of rights and freedoms (3,4) all recognize the importance of preserving privacy in a free society. With the arrival of the digital age and the relative ease with which huge databases can be created and exchanged, the risks to individual privacy have grown even more rapidly (12). Individual health care information, once entrusted only to one’s physicians or close family members, has now become routinely available to a much broader audience. Canadian Legislation:

To view the full article click on this link: http://www.insurium.com/articles/build-your-business-with-integrity-and-protect-the-confidential-information-entrusted-to-you.php

Workplace Bullying

BY; Martin Maylor, Insurium Inc.

75% of victims eventually left an organization because of bullying. Since over 80% of bullies were in management positions, they had some measure of power over their victim, which they exploited to their own sadistic ends. – Campaign Against Workplace Bullying (C.A.W.B)

(C.A.W.B) defines workplace bullying as; "the repeated, malicious verbal mistreatment of a victim (the recipient) by a harassing bully (the perpetrator) that is driven by the bully’s desire to control the victim."

The objective of any workplace bully is control, power, domination and subjugation. The means by which that objective is attained varies from bully to bully but can include deception, corruption and collusion, negligence, dereliction of duty, conspiracy, or even criminal acts.
The Canada Safety Council states that bullies tend to be insecure people with poor or non-existent social skills with little empathy. Like other criminal types they look for system failings and fester in the insecure corporation finding satisfaction in their ability to attack and diminish the capable people around them. A workplace bully subjects the victim to unjustified criticism and even minor fault finding. In addition, the bully humiliates the victim, especially in front of others, and ignores, overrules, isolates and excludes the victim.

"Most cases of bullying involve a serial bully: one person to whom all the dysfunction can be traced. The serial bully has done this before, is doing it now and will do it again. The serial bully in the workplace is often found in a job which is a position of power, has a high administrative or procedural content but little or no creative requirement." - Tim Field, a workplace bullying specialist based in the United Kingdom

According to Tim Field; The bully, is adept at escaping from accountability. This is largely because of their amazing ability to use deception and misperception to turn the tables on their accuser. Field notes that, when called to account, the bully instinctively denies everything and then mounts an aggressive counter-attack based on distortion or outright fabrication. The purpose is to avoid answering the question, thus avoiding the requirement of accepting responsibility for their behaviour. This tactic forces the victim into giving another long explanation to counter the bully’s allegations. Quite predictably, the bully’s original transgression is forgotten.

To view the complete article visit; http://www.insurium.com/articles/harassment-in-the-workplace.php

"In division there is opportunity".

Unless companies adopt an holistic approach to security that focuses on building and fostering a culture of honesty and integrity, GAP’s will appear in their defenses and in their ability to perform their mission; of selling their products and services. Once GAP’s are exposed, they can be exploited for the personal gain of the individual(s) exposing them. Once this occurs, the only question remaining will be; can you cope with the crisis being caused and to what extent is "damage control" required. Insurium has the solution www.insurium.com

In order, to adequately protect your corporate assets (People, Property, Income and Reputation), companies need to understand what they are exposed to. This requires a corporate understanding that integrates business and technological perspectives. When we speak of risks associated with assets, we need to evaluate all risks and incorporate these risks into our strategic and crisis planning. Implementing prevention strategies will ultimately reduce the risk of an occurrence. Occurrences could range from minor to major occurrences inhibiting a company from continuing its mission.

The risk of disaster and mismanagement are inherent in the corporate world and therefore, upper management should be responsible to ensure that the corporation is exercising the necessary amount of "duty of trust" and "duty of care". Reasonable efforts to investigate and become informed about the condition of the corporation, its assets and the conduct of its affairs would be seen as a responsibility "prudent" business men would exercise. For more information on The Insurium Solution visit; http://www.insurium.com/ or contact Insurium and request a copy of their book titled: PROTECTING YOUR CORPORATE ASSETS by Martin Maylor, Corporate Security Specialist and Crime Fighter

WAREHOUSE INVENTORY CONTROL
If like so many companies today you are faced with an ever growing labor shortage, fading knowledge due to increased retirements, GAP of skilled workers, stringent compliance and regulatory requirement aimed at safety and security.
The lack of standardization and / or implementation of procedures and policies between upper management and operations will create a GAP in business efficiency. With GAP’s like these there is little wonder why companies are facing inventory shortages / shrinkage and increased time waste and mismanagement.
In order to maintain optimal business efficiency the company’s directors need to take a positive leadership role. The lack of positive direction and reliable information will impair the company’s ability to ascertain;
Know the quantity, location, condition and value of it’s assets
Safeguard its assets from physical deterioration, theft, loss or mismanagement
Prevent unnecessary storage and maintenance costs or purchase of assets already in stock
Determine the full costs of programs that use these assets
Managing the acquisition, production, storage and distribution of products and services is critical to controlling costs, operational efficiency and mission readiness. Proper accountability requires detailed records of itemized or acquired products and materials are maintained. The costs associated with poor inventory management go far beyond that of an item of lost inventory.
Leadership is possibly the single most important element of a successful business and appears everywhere. Leadership and standards are set at the top management level and are filtered through every department.
Managers are required to provide an inspiring vision, make strategic directions that are understood and followed by all and instill values that guide subordinates. These philosophies and values provide focus, clarity and direction.
In order for a company to move forward with their objectives; maximizing revenues, containing costs and best manage their current assets, they need to take stock of their value and evaluate the risks facing these assets. Costs to a company from poor inventory management will vary considerably, yet, the following costs are seen frequently:
Time Mismanagement
Companies that have problems with inventory accuracy rates frequently have a time mismanagement problem where employees spend unnecessary time looking for items of inventory
Over Purchasing of Inventory
When inventory mismanagement is seen, it affects purchasing. If items of inventory are not located in stock (NIL) and in order to maintain customer satisfaction the purchaser replenishes items not found in inventory. If that item is later found in stock, this over-purchase can create an unnecessary cash shortage
Inventory mismanagement creates many unnecessary costs and provides an opportunity for unscrupulous employees to create inventory shrinkage. Insurium has created an inventory best practice that covers the following eleven modules;
Establish Accountability
Create Written Policies
Selecting an Approach
Frequency of Counts
Segregation of Duties
Enlisting Knowledgeable Staff
Supervision
Blind Counts
Physical Counts
Investigations
Evaluation
Case Study
A sixteen-year-old company that retained approximately $10 million in active inventory in three separate warehouses utilized a brand name computerized inventory software system to track and maintain each item. These items of inventory were provided a unique personal identifier.
The company’s accuracy rating for inventory was less than 50% even though they had incorporated RFID technology to track individual items.
We found inadequate leadership from executive management, which resulted in middle management taking control of inventory. The middle managers manipulated the inventory software system. This lack of management and knowledge allowed middle management to make up their own rules allowing themselves to write off inventory at will or switch RFID numbers of good condition inventory items to those that were returned broken. Not only did we identify lost inventory rates of approximately 50% but also, we identified losses exceeding $250,000 per year.
The Insurium Inventory Best Practice will demonstrate how to avoid these pitfalls and implement strategies that enable inventory accuracy rates.
For more information on how to obtain your copy of this booklet contact Insurium at info@insurium.com

THE HIDDEN COST OF INSURANCE FRAUD

Disclaimer; This publication by Marwen Consulting Group Inc., has been provided as a service to our customers and is meant for informational purposes only. Although this information has been researched exhaustively, the author assumes no responsibility for its accuracy, errors or omissions herein. Readers should use their own judgement or consult a legal consultant for specific advice. The following represents materials compiled from various sources; public resource, Insurance Institutes, claims forums, international news forums as well as information from our own files and sources.

In about one fifth of all known cases of health care fraud, consumers are the perpetrators, according to the insurance association. All but a fraction of the rest involve providers. "I don't take consumer fraud lightly," says Greg Anderson, director of corporate finance investigations for Blue Cross-Blue Shield of Michigan. "We have 4.5 million customers and if each one is doing $1 in fraud, that's $4.5 million. That's worth paying attention to." But provider fraud is where the bigger dollars are by far.

That's not surprising, says the Anti-Fraud Coalition's Mahon. "A consumer has a health plan, car insurance, a vision plan, maybe dental, but a provider has the whole patient population, the whole range of tests and treatments and the ability to bill a very wide array of third-party payers. Even in a managed care setting, if I'm a provider, I'm participating in a dozen or two plans, plus all the fee-for-service plans," he points out.

In the indemnity world, provider fraud falls into one of two categories, whether it's the work of a single doctor, an organized gang or a hospital or clinic: billing for services not rendered - tests not given, surgery not done, care not provided - and upcoding. A physician may spend just a moment with an office patient but bill for a full evaluation, for instance, or bill for foot surgery when he did little more than trim the toenails of a nursing home patient. "These account for 100 percent of the provider fraud in fee-for-service plans," says Anderson.
But 85 percent of patients with employer-based coverage now are enrolled in some kind of managed care plan. Under plans that are not fully capitated, most of the same variations of provider fraud still apply. New methods also are emerging.
Kirk J. Nahra, general counsel for the National Health Care Anti-Fraud Association, noted in a 1997 article in Benefits Law Journal that fraud continues to flourish the old-fashioned way. That's because "fee-for-service transactions continue to figure significantly in virtually any managed care system," he wrote. With some HMOs diminishing the role of - or doing away with - gatekeepers, such transactions are not about to disappear.

When providers share the financial risk, however, they have an incentive to provide less care - and that can be a subtle problem to detect. This might range from simple inadequate treatment to the "automatic" referral of sicker - and thus more costly patients to specialists outside the capitated network, perhaps in exchange for kickbacks. It might also include such subtle acts as the establishment of inconvenient service locations or appointment hours for managed care patients, "designed to suppress patient traffic," Nahra wrote.

Initially, fraud squads will detect these kinds of abuses through statistical analysis, he predicts. But he cautions that legal proof won't be easy. In a case where a provider has systematically provided low levels of services to capitated patients, for instance, prosecutors will have to show that providing reduced care is a "scheme to defraud."

Insurers told the HIAA that they'd uncovered a wide range of managed care provider fraud. Ripoffs ranged from the embezzlement of capitation funds to falsifying new enrollee registrations, falsely elevating encounter rates in an effort to increase future capitated payments, illegally balance-billing patients and overcharging for copayments. Doctors also undercharge for copays in an attempt to lure more patients, either to collect more capitated payments or to use the insurance information to submit false claims.

In still another managed care scheme, the gatekeeper or PCP accepts kickbacks in exchange for referring almost exclusively - and more often than is genuinely necessary - to particular specialists, says Greg Anderson, director of investigations for Michigan Blue CrossBlue Shield. Although some plans reward doctors for keeping referrals to a minimum, physicians who accept kickbacks can more than make up for any incentives they might forfeit. And, says Anderson, "Kickbacks are really hard to prove."

Some investigators also suspect that private capitated plans are being charged for excessive lab services and testing by some hospital emergency departments, which can bill them separately. Another variation: routinely admitting patients at 11:55 p.m. instead of 12:05 a.m., to collect for an extra day's stay.

Higher Insurance Rates
The Canadian Coalition Against Insurance Fraud defines insurance fraud as any act or omission with a view to illegally obtaining an insurance benefit -- in other words, any action where a claimant walks away with money that he or she is not entitled to.
Insurance fraud includes a full range of fraudulent acts. Examples include: completely fabricated claims, inflation or padding of genuine claims, false statements on insurance applications, and internal fraud.

Fraudulent claims represent approximately 10 to 15% of claims paid out. General insurance fraud amounts to approximately $1.3 billion per year in Canada. Honest policyholders through increased premiums pay this cost.

When the toll on other societal resources is factored in, insurance fraud costs an additional $1 billion per year. Police must investigate crimes in which the details have been altered, making the investigation more costly and time-consuming, or which, in fact, never occurred; firefighters risk their lives and expend valuable resources to extinguish arson fires; fire marshals investigate the cause of the fire; health service providers treat patients injured in arson fires or staged accidents, or who fake injury to make claims.

Higher Costs For Your Health Insurance
Americans pay about $ 1 trillion in health care costs per year. According to the United States General Accounting Office, 10 percent of what we spend on health care is fraudulently billed in services not rendered, overcharges, duplicate charges and other health fraud schemes. That means that $100 billion per year is fraudulently billed!

How much health care can be delivered for $100 billion?
$100 billion would give every man, woman and child in the United States and Canada a complete health examination and physical

$100 billion would pay for 20 million days in an intensive care unit at a hospital.

$100 billion would pay for 40 million CT scans.

Some common frauds of concern to insurers;
Employer Fraud
There are two types of employer fraud in workers compensation: that which is claims related and that which involves policy premiums. This is an area where others outside of the claims function, premium auditors, for example need to be vigilant for suspicious activity.
Employer claims fraud occurs when an employer knowingly misrepresents the truth in order to avoid, deny or obtain compensation on behalf of it’s employees; or knowingly lies about entitlement to benefits to discourage or encourage an employee from pursuing a claim. Employer premium fraud occurs knowingly lies in order to obtain a workers compensation insurance policy at less than the proper rate; e.g. :
Misrepresenting the risk of exposure for a given insured by; under-reporting payroll, mis-classifying payroll, reporting an injury under insured company “A” when in fact the injured employee was an employee of uninsured “B”, lying about the company ownership to avoid high experience modification.
Some Red Flags:
The injured worker is a new hire
The applicant took unexplained excessive time off prior to the claimed accident\injury
The alleged injury occurs prior to or just after a strike, layoff, plant closure, job termination, notice of company relocation etc....

Lawyer Fraud
Such fraud arises when lawyers knowingly participate int the misrepresentation of the truth in order to either secure or deny compensation for their clients and \ or themselves. E.g:
Knowingly assisting a client in pursuing a false claim
Soliciting a person to file a claim
Knowingly pursuing collection of a lien the lawyer knows to be fraudulent
Related criminal acts that feed fraud, such as accepting consideration from or paying consideration to doctors, vendors or others for referral of clients or settlement of cases.
Red Flags:
The majority of claims in which a law frm is involved are of a highly questionable nature
A letter of representation is received, but the applicant denies representation or meeting with the lawyer.
In what is referred to as solicitation fraud, several employees from the same employer have reported similar injuries and are represented by the same law firm.

Adjuster \ Examiner Fraud
This occurs when a claims person purposely misrepresents the truth in order to either deny or support a claim; or offers or accepts any form of consideration for the referral or settlement of a claim. When the fraud involves compensation in the form of “kick-backs” as a reward for being given a contract or business, these frauds are particularly difficult to detect since the compensation is paid directly to the employee and does not go through the company books. Sometime’s it happens that an employee has an undisclosed interest in a transaction that results in harm to the company because the price of the contract is not in the best interests of the company. E.g..:
Accepting a gift such as a television or a trip from a vendor in exchange for implied promise of referrals.
Knowingly referring cases to a vendor when the services of that vendor are not required in exchange for consideration.
Altering the evidence in a claim in order to support denial or approval.
Red Flags
Inconsistent application of cost containment measures or agreement to pay above the fee
schedule.
Sloppy observance of procedure for referrals to outside vendors or increase in the use of a specific vendor.
Personal relationships with an outside contractor

Marwen Consulting Group Inc., a global fraud investigation agency headquartered out of St.Albert, Alberta, Canada. For a list of our services, please feel free to visit our website; www.marwen.ca or contact one of our experienced consultants.

For information on any of the literature completed by Mr Martin Maylor ; “The Effective Management Of Surveillance Services” or to inquire about educational seminars please contact Martin directly at m.maylor@marwen.ca

managingcorporatefraud

"http://www.marwen.ca/files/Bridging the GAP in Escalating Insurance Claims.pdf"

17 Busted For No-Fault Insurance Fraud Scheme

NEW YORK---Seventeen people and three corporations have been indicted on charges that they engaged in an elaborate scheme to defraud no-fault insurance carriers.

Attorney General Eliot Spitzer also released a comprehensive report detailing the office's accomplishments as the state's special prosecutor for auto insurance fraud. "Auto insurance fraud hits consumers and businesses hard. Targeting those who cheat the system is beginning to bring premiums down for the law-abiding public," Spitzer said. "Over the last five years, the auto-insurance fraud unit has cracked down on lawyers, health professionals, and phony accident victims who have cheated us through lucrative and complex no-fault schemes."

The defendants are charged in three separate indictments unsealed last week by Justice Joseph Kevin McKay in New York State Supreme Court, Kings County.

In the first indictment, three defendants, including a doctor and a medical clinic owner, are charged with enterprise corruption, a class B felony. The defendants allegedly earned millions of dollars through their operation and control of AR Medical Art, P.C. (AR Medical), a medical clinic in the Midwood section of Brooklyn that "treated" persons purportedly injured in car accidents.

Other charges in the indictment include scheme to defraud, money laundering, grand larceny, insurance fraud, falsifying business records, and offering a false instrument for filing.

The Attorney General has also brought a civil case against the defendants seeking the forfeiture of over $3.9 million in illegally obtained proceeds. As part of that case, the Attorney General has obtained a court order freezing assets--including bank account proceeds and real property- of Inna Polack, 36, of Staten Island; and Dr. Alexander Rozenberg, 52, of Brooklyn; and three corporate defendants. The order was issued by Justice Ira B. Harkavy of Kings County Supreme Court, civil term.

In the two other indictments unsealed Monday, 14 people were charged with staging car accidents throughout New York City and attending clinics, including AR Medical, for treatment of their feigned injuries. These two staged accident ring indictments charged the defendants with scheme to defraud, insurance fraud, larceny, falsifying business records, and offering a false instrument for filing.

All three indictments allege that the defendants submitted fraudulent no-fault claims to insurance carriers. The no-fault law governs the provision of medical care to people injured in car accidents.

The enterprise corruption indictment alleges that although the owner of record of AR Medical was Dr. Alexander Rozenberg, a physician specializing in physical rehabilitation, he did not control the operations or the financial affairs of the clinic. Instead, Inna Polack, who lacks a health provider license, secretly owned the clinic and decided what medical and health services were to be provided to patients. The defendants acquired patients through a network of "steerers," who were paid to refer patients to AR Medical. Steerers solicited patients by staging motor vehicle accidents and by offering the clinic's "services" to real car accident victims. Shaun "Prince" Robinson, 36, of Brooklyn, is charged as a steerer in one of the staged accident ring indictments. Glen "AZ" Elfe, 37, of Fresh Meadows, is charged as a steerer in the other. Robinson and Elfe allegedly staged accidents by recruiting individuals to pose as injured pedestrians or bicyclists, and also recruited individuals to pose as witnesses.

The indictment further alleges that, following referrals of patients to AR Medical, Rozenberg conducted cursory medical evaluations, fabricated patients' symptoms, falsely diagnosed extensive soft tissue injuries, and referred patients for prolonged, unnecessary treatment and testing. This treatment included months of physical therapy, chiropractic care, acupuncture, and psychological counseling, as well as MRIs, x-rays, and nerve testing. Natalya Shvartsman, 47, of Brooklyn, a manager of AR Medical, is charged with furthering the clinic's corrupt activities by ensuring that patients received such treatment and testing and by submitting fraudulent claims to no-fault insurance carriers.

Additional defendants named in the enterprise indictment are: Mighty Management L.L.C., and Mighty Management Group, Inc., two Brooklyn-based management companies, both owned by Polack, allegedly used to launder funds of the enterprise.

The additional defendants charged as members of the staged accident ring headed by Shaun Robinson are: Todd Brown, 39, Kevin Plummer, 39, Timothy Britt, 36, Tony Dubose, 28, Alan Washington, 28, Eric Cummings, 35, James Foster, 46, Marvin Shine, 40, and Jason Robinson, 26, all of Brooklyn.

The additional defendants charged as members of the staged accident ring headed by Glen Elfe are: Shawn "Mel" Thomas, 39, Bruce James, 33, and Joseph Tabois, 25, all of Brooklyn.

The prosecutions stem from a joint 20-month investigation conducted by Attorney General Spitzer's Auto Insurance Fraud Unit and the New York State Insurance Department's Fraud Bureau, and the New York City Police Department's Fraud Accident Investigation Squad. The investigation included the use of court-authorized wiretaps.

Since January 2002, when it made its first series of arrests, the Auto Insurance Fraud Unit has brought felony insurance fraud and related charges against 300 defendants.
Posted in North County Gazette, July 31, 2006

Response to article - October 15, 2006

www.insurium.com is an integrity company who advises companies how they can protect themselves against fraud. They do this by helping companies understand the root cause asociated with fraud.

Insurance fraud has been around for centuries and insurers have failed to protect honest policy holders against it. Insurers have taken the easy way out, by spending a little money on evaluating the cost, then directed that cost back to the consumer - because of this tactic, there is little incentive for them to change their ways or views. It's not just individuals who commit fraud, corporations, institutions and governments have all been caught comitting fraud. If insurers want to raise the bar, then firstly, they will need to take a good hard look at themselves to see if they are vulnerable.

Insrers have many tools at their disposal to help them fight fraud, but how do they evaluate which tool to use and who decides which one to use, what criteria do they use and in the selection process, is there somewhere that evaluates the reasoning behind their decision. In a case listed below, I would like to take a look at why The City of Edmonton managed to secure a landslide decision in their case and yet, Gerhardt's partner who was simultaeneously investigated ended up securing a "golden handshake" for his part in the fraud. The partners claim was being adjudicated by the insurer, who hired their own investigator to gather evidence concerning the claim. This investigator gathered no evidence whatso ever. While the City of Edmonton instructed their own people on Gerhardt. Why was the insurers investigator unable to obtain evidence when City gathered so much?. The investigations were performed simultaneously. All things are not equal.

http://www.marwen.ca/files/LBJun2004-1.pdf

To find out how insurium can assist your company fight fraud visit them at www.insurium.com

managingcorporatefraud

	Web scams18.spaces.live.com fraudpreventionanddetection.blogspot.com

It doesn't need to be a bridge too far - Insurium

Bridging the Management GAP in Escalating Insurance Claims

While insurance fraud schemes have evolved over time to fit within the circumstances of modern society, the foundation of them has been in place for centuries….

Insurance fraud is one of the real threats facing the industry. The growth of the claims culture, together with research shows consumers believe insurers are ‘fair-game’, making for a dangerous combination. The costs to manage these claims come with a risk factor; bad faith suits, medical expense, investigation expense to name but a few. The utilization of third party providers to assist in managing these claims has opened the door to the added risk of provider fraud. The cost to the industry is enormous and affects the way the public view insurance companies and their service offerings.

MetLife director of special investigations, John Sargent stated in an article "that eliminating fraud is an unachievable goal". But that hasn't stopped his company or other industry leaders from trying. "Our goal is to pay what we owe, and not a penny more or a penny less," Sargent says. "The more efficient we are at identifying and preventing fraud, the better we can be at writing business at a more competitive rate."

Insurance fraud costs Canadian policyholders over $1 billion each year. To the average Canadian citizen, that means at least 10 percent of their total insurance premiums are used to cover the cost of fraud.
http//:www.insurance-canada.ca/claims/canada/CCA1F200212

To view the full article go to

http://www.marwen.ca/files/Bridging the GAP in Escalating Insurance Claims.pdf

Gerhardt versus The City of Edmonton saw a landslide victory for the city. Backfground; a long term employee who had a history of taking unwarranted time off work sued the city for wrongful dismissal after being videotaped working for self while collecting benefits. The investigators testimony enabled the city to secure it's result. The twist; Gerhardt, had a partner - also an employee of the City and also collecting benefits on Long Term Disability. The insurer contracted a private investigator to follow the partner at the same time the Gerhardt investgation was being performed. This investigator gathered no evidence and the partner secured a "golden handshake" - all things are not equal say Marwen, the company who investigated Gerhardt. Read an article submitted by an unbiased lawyer:

To view the article go to

http://www.marwen.ca/files/LBJun2004-1.pdf

The interesting thing about this article is that it was all preventable. The first article written by Insurium briefly talks about prevention and root cause.

Look for our next post on fraud and how to prevent it