WORK COMP FRAUD: SPOT IT & STOP IT! 10 Steps to Prevent - - PowerPoint PPT Presentation

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WORK COMP FRAUD: SPOT IT & STOP IT! 10 Steps to Prevent - - PowerPoint PPT Presentation

Sep 22, 2023 112 likes •462 views

WORK COMP FRAUD: SPOT IT & STOP IT! 10 Steps to Prevent Fraudulent Claims Presented by ICW Group Special Investigation Unit TODAYS SPEAKERS Lindsey Beacom Tracy Crates Senior Investigator Supervisor Special Investigation Unit Special

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10 Steps to Prevent Fraudulent Claims

Presented by ICW Group Special Investigation Unit

WORK COMP FRAUD: SPOT IT & STOP IT!

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Lindsey Beacom

Senior Investigator Special Investigation Unit ICW Group

TODAY’S SPEAKERS

Tracy Crates

Supervisor Special Investigation Unit ICW Group

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  • What is work comp fraud?
  • Top 10 ways you can prevent fraudulent claims
  • Investigative resources
  • How ICW Group SIU is here to help

TODAY’S TOPICS

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MATERIAL MISREPRESENTATION

WHAT IS FRAUD?

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MATERIAL MISREPRESENTATION

INTENT

WHAT IS FRAUD?

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MATERIAL MISREPRESENTATION

INTENT LIE

WHAT IS FRAUD?

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MATERIAL MISREPRESENTATION

INTENT LIE KNOWLEDGE OF LIE

WHAT IS FRAUD?

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MATERIAL MISREPRESENTATION

INTENT LIE KNOWLEDGE OF LIE

WHAT IS FRAUD?

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WHY SO BIG?

  • Health system is an easy target
  • Low-risk crime
  • Low legal priority
  • Climate of tolerance
  • Weak public outreach
  • Unaggressive insurance companies (not us!)

FRAUD IS A BIG BUSINESS!

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Let’s look at the top 10 ways!

YOU CAN PREVENT FRAUD

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KNOW WHO YOU HIRE

  • Conduct as much vetting as

possible.

  • Always perform thorough pre-

hire background check.

  • Maintain current records of all

employees.

10 WAYS TO PREVENT FRAUD

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10 WAYS TO PREVENT FRAUD

DON’T HESITATE, EDUCATE

  • Educate employees on benefits.
  • Provide training on work comp

process & state disability if injured outside work.

  • Ensure employees know

protocols when injuries occur.

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MANAGER TRAINING

  • Confirm managers &

supervisors know process.

  • Train on proper injury

investigations.

  • Don’t ignore reports of injury.
  • Document ALL complaints.
  • Report all injuries to ICW Group.

10 WAYS TO PREVENT FRAUD

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10 WAYS TO PREVENT FRAUD

ZERO TOLERANCE

  • Implement stringent policy

against all suspected fraud

  • Utilize anti-fraud resources on

the Policyholder Center.

icwgroup.com/fraud

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SAFETY MEETINGS

  • Institute monthly or quarterly

safety meetings.

  • Work with ICW Group Risk

Management.

10 WAYS TO PREVENT FRAUD

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10 WAYS TO PREVENT FRAUD

DON’T IGNORE COMPLAINTS

  • Listen to employee complaints
  • f poor treatment or unsafe

conditions.

  • Provide resolutions to

complaints for employee morale.

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SURVEILLANCE

  • Invest in security cameras.
  • Use to validate legitimate injury.
  • Preserve video evidence for

future use.

10 WAYS TO PREVENT FRAUD

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10 WAYS TO PREVENT FRAUD

INJURY INVESTIGATION

  • Complete R.E.P.O.R.T. worksheet!
  • Take pictures of accident site &

review surveillance.

  • Report suspicions to ICW Group

Fraud hotline.

855.ICW.FRAUD

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SHOW THEM YOU CARE

  • Check in with injured worker.
  • Assist when needed.
  • Answer questions about the

work comp process.

  • See Injured Worker Ecards on

Policyholder Center

icwgroup.com/pc

10 WAYS TO PREVENT FRAUD

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10 WAYS TO PREVENT FRAUD

EXIT INTERVIEWS

  • Rule out any injuries sustained

during employment.

  • Sign declaration of no injuries.
  • Ensure worker knew how to

report injuries if they occurred.

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Guiding your investigative process

R.E.P.O.R.T.

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R.E.P.O.R P.O.R.T .T.

Six critical elements of your investigation

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EVERY claim reviewed for fraud within 24 hours Vetted against 3,000+ red flag/data points If fraud likely, referred for criminal investigation & prosecution 5x claims investigated vs. industry average

ICW GROUP HAS YOUR BACK

All claims checked throughout entire lifecycle – even after close!

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5,506

cases investigated

33K

surveillance hours

600

criminal counts filed

$68.6M

reduced claim costs for policyholders

10

criminal organizations disrupted (3 totally dismantled)

PAST 18 MONTHS…

FIGHTING FRAUD FOR YOU

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1,000+

field investigators

24/7

unmanned surveillance

200+

social media site checks per claim

MULTI-LEVEL INVESTIGATIONS

FIGHTING FRAUD FOR YOU

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A.I.M. Analysis & Investigation Module

  • Exclusive software created for you
  • 4TB+ of proprietary data
  • 12K+ data points for accurate,

real time fraud detection

HOW WE’RE DIFFERENT

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WORK COMP FRAUD: SPOT IT & STOP IT!

YOUR ANTI-FRAUD RESOURCES

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WORKPLACE MATERIALS

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icwgroup.com/pc RESOURCES:

  • Risk Management
  • Claims
  • Payroll Reporting
  • Injured Worker Resources
  • Anti-Fraud Materials

POLICYHOLDER WEBSITE

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icwgroup.com/fraud ANTI-FRAUD MATERIALS

  • Workplace Posters
  • Webinars
  • Employee Campaign
  • R.E.P.O.R.T
  • “False Claims” Ticket

POLICYHOLDER WEBSITE

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FRAUD FIGHTING PARTNERSHIP

Our culture was wrought with fraud until I partnered with ICW Group.”

  • Jerry Salveson, Andrew Lauren Interiors
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FraudUnit@icwgroup.com 855-ICW-FRAUD (855.429.3728)

QUESTIONS?

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Anti-fraud materials:

icwgroup.com/fraud

THANK YOU!