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New Jersey Special Investigators Association, Inc.

2018 Workshops (subject to change)

AMBULANCE CHASERS AND DOCTOR DEBASERS:  The Run-Down on the Use of “Runners”  

Ashley R. Lynam, Esq.

Michael Benjamin Gerstein, Esq.

This course will cover the rules and regulations that govern attorney solicitation in New Jersey, Pennsylvania and New York. The presentation will provide the audience with applicable statutory and case law governing what methods attorneys are prohibited from engaging in when seeking to represent personal injury victims. In addition to discussing attorney proscriptions on the use of runners, this course will explore to what extent regulations are in place to prevent medical professionals from referring patients to attorneys for financial gain. Finally, the presentation will engage in a thorough discussion on investigative techniques designed to learn of the practice of solicitation and how the information gained can be utilized in fighting potential fraud.

AUTO ACCIDENT REFERRAL NETWORK SCHEMES: FOCUS ON SOLICITATION METHODS

Ken Pringle, Esq.

Ben Hickey

Lori Smith

This course will provide valuable insight into the infrastructure of referral network schemes, with a particular focus on the methods used to solicit automobile accident victims on behalf of the attorney and provider participants in these networks. The speakers will discuss techniques for identifying the participants in these networks, outline evidence they have recently obtained about solicitation methods used to recruit clients/patients, and discuss tools and techniques SIU investigators and attorneys can use to investigate, disrupt and defeat these schemes.

AUTO THEFT STATS & FACTS

Glenn Hennings

This workshop will be covering the latest theft information and trends, and updates in vehicle technology.

AUTOMOBILE FINANCE FRAUD – AUTOMOBILE STRAW PURCHASING

Jarek Pryzanowski

The course is designed to demonstrate how auto finance fraud, auto used car dealer fraud, and automobile straw purchasing is the new face of auto theft. This activity is often mis-categorized by financial institutions and insurance companies as an identity theft or credit loss, and is considered by law enforcement as a civil matter. The course will show clear examples of organized criminal activity, money laundering, and insurance fraud on a local, national and international scale. The presentation will discuss many fraud related crimes involving vehicles, such as subleasing scams, title fraud, identity theft / synthetic identity, straw buyers and why they should be considered criminal offenses as opposed to civil.

CIFI PREP

(All attendees are welcomed)

Joey Cox

There are many benefits that IASIU provides to its membership and most importantly to our industry. We are highly dedicated in promoting professionalism throughout our industry and offer three designation programs that aids in building one’s skills and knowledge. The Certified Insurance Fraud Investigator (CIFI) program is an accrediting process for individuals having specialized skills required to detect, investigate and deter insurance related crimes and fraud. Another is the Certified Insurance Fraud Analyst (CIFA) program that is an accrediting process covering topics that deem an analyst to be well rounded and versed in all aspects of fraud analytics. The third program is the Certified Insurance Fraud Representative (CIFR) designation that was designed to recognize those fraud awareness conscious claim representatives who are passionate about fraud detection and work closely with the SIU and analytical teams on a daily basis.

Holding one of the IASIU certifications ensures consistent high standards throughout the industry and provides acknowledgement of an individual’s dedication and qualifications when performing their duties while inspiring and promoting public confidence, trust, integrity, objectivity and professionalism. All three programs have high standards for admission and testing, which includes adherence to IASIU’s code of ethics and a demonstrated competency through mandatory continuing professional education.

An Insurance Fraud Investigators Role (CIFI Prep 1)

Learn to interpret the methods of insurance frauds and how to detect, investigate and deter insurance fraud by recognizing the red flags. Review the steps of an insurance fraud investigation from planning the investigation and interviewing prospective witnesses. The instructor will equip candidates with helpful tips for taking the CIFI exam, comprehensive information on the core content covered in the exam, and the ability to answer complex questions about the material.

Requirements of the Policy and the Law (CIFI Prep 2)

Examine the legal issues that affect insurance fraud investigations including rules of evidence, key legal rights and policy issues. Many insurance fraud investigators experience avoidable issues and will discuss elementary legal concepts of an insurance fraud investigation. An insurance fraud investigator who acts irresponsibly, without a valid basis on which to take each step in the investigation, or in violation of the rights of the subject can be liable for civil actions.

Recognizing Fraudulent Activity (CIFI Prep 3)

Types of insurance fraud being committed daily, the types of scam being performed against the carriers and insureds, the types of investigations that are available to you, how and why an investigator conducts their investigations. Detect fraudulent insurance activity and conduct risk assessments.

COURTROOM TESTIMONY & DEMEANOR-QUALIFIED SUCCESS

Gregory J. Harlin

For many of us, the courtroom is like a foreign land and the internal dynamics of the court is like a foreign language that appears to change each time we enter its domain. It seems as each day passes a new law, a new opinion, a new restriction or a new restraint is decided that affects our ability to function and perform our duties effectively. As the protectors of society and the enforcers of the law, we exhibit strength, confidence and assertiveness in public but when we are alone on the “Hot seat” (the stand) in court, our demeanors change and at times we appear aloof, uncomfortable, frustrated and weak. This brief training will highlight several dynamics concerning court preparation, dress, testimony presentation empowerment and defense tactics.


FROM THE CRADLE TO THE GRAVE

A Touching Story of a Fraudulent Claim from Referral to Conclusion

Lee Befeler, Esq.

Danyelle Golland, Esq.

Rafael A. Llano, Esq.

Kelly A. Sherwood, Esq.

In this workshop, we will discuss the handling of a claim from its inception through its conclusion. The claim will involve investigation of a fictional loss. The investigation of this fictional loss will involve:

a. Misrepresentations regarding the date, time and location of a loss;

b. Intentional damage done to a vehicle at a body shop;

c. PIP fraud in connection with a neurosurgical procedure; and

d. A homeowner’s claim involving stolen memorabilia and intentional damage.

The fictional matter will involve an insured calling to report an accident approximately two months after the accident occurred. The insured provided cell phone photos of the accident that were examined for metadata and found to have been taken on a different date and time. The car is then taken to a body shop where enhanced damages are done to the engine. Metadata is again used to show photographs of the engine in perfect condition and then the engine in a damaged condition.  This workshop will discuss ways that SIU investigators and attorneys can use their experience to defend and investigate claims. The workshop will discuss ways to obtain documentation of the fraud as well as to defeat the claims in Court.

MAJOR CASE FROM A TO Z

Jeff Rapattoni, Esq.

Building a successful Major Case program is difficult. There are numerous variables to consider in an environment that is anything but stable. If you are not careful, in the blink of an eye, the protocol becomes stale, the ROI drops and severity goes up.

This class is designed to be a tutorial of what to have in a successful program, advices for a competitive edge and what not to do.

Topics will be arranged in a format that is useable and clear so as to provide the best possible takeaway.

All salient aspects of modern day Major Case will be touched upon.


NJ LEGAL UPDATE AND THE INTERPLAY WITH INSURANCE FRAUD

Matthew Werbel, Esq. & Stephen Katzman, Esq.

This session will focus on the recent case law and legislation in New Jersey and its relevance to insurance fraud. We will also discuss developments and changes in New Jersey law and the impact it has on the insurance industry. Since insurance fraud always seems to find “weaknesses in the system”, we hope to identify the issues in these developing areas to provide proactive guidance to investigate and litigate them.

PROPERTY ANALYTICS

Aaron Brunko

QUICK HITTERS

Gregory E. Peterson, Esq.

1) Rescission update, new cases

2) Boardable medicals/excess medicals

3) Microexpressions

This presentation is broken into three, 20 minute "blocks" covering different, cutting edge, fraud issues. The first block addresses developments in underwriting fraud and policy rescissions; Block two explores fraud concepts in the rapidly evolving area of claims for unpaid medicals in bodily injury litigations. The third block is a layman's discussion of social psychology in understanding witness behavior during the interview and examination under oath.

Radiology Schemes: Lessons Learned and Problems to Expect

Rick Wakefield

In the property casualty arena, the most common and easiest to identify is improper billing. The least common type and most difficult to identify is the payment rules. Improper relationships fall in between. Most fraud happens when claimants are prescribed diagnostic imaging that were not medical unnecessary, including multiple scans of the same body part for the same patient that are weeks apart and performing and billing for CT scans related to medical unnecessary injections and ignoring or stopping documentation of statements and complaints from patients that the injections were not working or not wanted. As investigators how do we pick up on the improper relationships and gain the insight knowledge to combat these types of schemes. Over the next hour, small pearls of knowledge will be given to understand certain terms in radiology, most common unbundled codes, double billing and the laws and regulations and creating an environment where it is more difficult for the fraud to occur.

SELF DEFENSE -KRAV MAGA TRAINING
Don Melnick and Sarah Mantz

Krav Maga is a no-nonsense, practical, instinctive and effective self-defense system, not a sport-oriented martial art. Designed for everyone - regardless of gender, age, size, shape, physical ability or experience - Krav Maga will teach you how to diffuse a negative situation to keep you safe.

Led by senior instructors from Israeli Krav Maga, this session will cover the basics of self-defense --> Awareness & Avoidance, and in worst case scenarios, how to deal with active threats where you need to protect yourself by any means necessary. This may include multiple strikes to the groin, throat, eyes and other soft targets.

You may be your first, last and only line of defense in an increasingly violent world, and must be prepared to do whatever it takes to survive. Most important… there are NO rules on the street.

SETTLEMENTS AND JUDGMENTS: GETTING TO THE MONEY

RICHARD E. VUERNICK, ESQ.

This course will explore several issues to consider when settling major case litigation, including and especially legal issues surrounding Confidentiality Agreements, Billing Moratoria, Penalty Provisions and Consent Judgments. Additionally, the course will discuss several relevant “nuts and bolts” aspects of docketing and executing on a judgment. We will examine such post-judgment tools as the Information Subpoena, discovery and the request for and implementation of a charging order.

SPOTTING FRAUD IN SELF-SERVICE

Aaron Brunko

Don’t forget about fraud, when collaborating more with claimants to improve efficiencies and customer satisfaction in claims workflows.

THE PROOF IS ON THE PORSCHE – INTERPRETING DAMAGE TO IDENTIFY FRAUD

Steven Teterus

Does the driver’s story match the story told by their vehicle? This course will teach you about the forensic tools and methods available for obtaining the unbiased version of events told by the vehicle. How can you tell if two vehicles came into contact? Was the car moving when the damage occurred? How can black box data defeat vehicular fraud? What are the indicators of a staged collision? Case studies will be provided.

The SIU Investigator Perspective Roundtable: Complex Organized RING Cases

Tara Arce

Reid Caster

Jack Coperus

Rick Matarante

Moderator: John Butchko

This session will moderate an open discussion for attendees as the panel members provide insight on the handling and development of complex fraud investigations inclusive of gathering case intelligence, case characteristics, workflows, tools, partnerships and desired case outcomes for all lines of business (property, auto, medical, life etc.).

THE USE AND ABUSE OF PAIN MANAGEMENT IN ACCIDENT CLAIMS

Vincent Gerbino, Esq. & Matthew Smith, Esq.

The rapid growth of pain management in minor accidents has resulted in a monetary increase in the payout of first party claims as well as an increase in settlements where a $5,000 settlement has become a $100,000 demand based upon the use of pain management in the treatment of the claimant.

Pain management incorporates services consisting of the use of pain management medicines/opioids, expensive compound creams, trigger point injections, facet joint injections and epidural injections usually performed at ambulatory surgical centers. These services enhance the value of a bodily injury claim by permitting counsel to argue that their client has undergone a surgical procedure. Each and every trigger point injection and/or epidural injection increases the value of the claim causing soft tissue/low impact claims previously settled for $5,000 or lower to become high value cases with settlement demands exceeding $100,000.

Our session will explore what investigations have uncovered about the overuse of pain management treatments such as injections, creams and opioids as well as the strategies for attacking the abuse and resolving claims.

UNDERSTANDING THE NEUROLOGY EXAM AND THE EMG FINDINGS

Dr. John Robinton

This course offering will provide a basic overview of the neurologic examination which is an important component supporting claimed injuries in accident files. Neurologic examination findings are utilized to support additional testing, invasive treatments and claims of disability. In addition to describing the various components of the examination, useful clues will be provided to help identify suspicious exam findings. In the second portion of the presentation, the significance of finding of the EMG and nerve conduction study will be reviewed. Videos will be presented that demonstrate the significant abnormalities noted on the needle EMG. This is intended to be an interactive presentation utilizing questions from the audience to enhance understanding the subject materials.

USING LAW ENFORCEMENT TACTICS AND TECHNOLOGY TO SPOT CLAIMS FRAUD

David Rivera, Joe Brady and Rachel Cracchiola

Through Event Links, DRN provides SIU investigators with the same commercial license plate recognition (LPR) data that law enforcement agencies across the country use every day to develop investigative leads. Using the power of LPR data or vehicle sightings, learn how to investigate cases and catch fraud.

Join Dave Rivera, retired NYPD Detective, Paige Burley, former crime analyst, and Rachel Cracchiola of DRN’s insurance team and find out how to use LPR data to investigate:

- Garaging Fraud

- Commercial Use of a Private Vehicle

- Workers Compensation/Bodily Injury Claims

- Fraud Ring/Collusion with an Unknown Vehicle

- Stolen Vehicles

- Pre-existing Damage

Water Loss Fraud (“Water Arson”)

Jay F. Kramarczyk, MS, PE

This class is designed to explain some common non-fraudulent water losses as well as what to look for when fraud is suspected. This class utilizes a number of examples and a large-loss case study. It provides red flags for claims and SIU personnel to be mindful of and explains what services and expert should be able to provide.

What is PASS THROUGH BILLING?

Lorraine Buckman

Pass-through billing takes place when an ordering physician requests a service and bills insurance companies for the service but does not perform the service, nor does anyone he employees perform the service. Insurance companies prohibit this practice. We will discuss the different types of pass-through billing and ways to detect and prevent this billing.


WORKERS’ COMPENSATION PREMIUM FRAUD - INVESTIGATION AND PROSECUTION

Neil Johnson, CFE

Det. Megan Flanagan

WC SURVEILLANCE

Matt Anderson

Jason Gudaitis

Kristie Prococino

 

 

 

 

 


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