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SITA Conference Cincinnati Oct. 5, 2009 Mission and Vision Mission: To lead a united effort of insurers, law enforcement agencies and representatives of the public to prevent and combat insurance fraud and crime through Data Analytics, Investigations, Training, Legislative Advocacy and Public Awareness. Vision: To be the preeminent organization fighting insurance fraud and crime. NICB Disciplines • • • • • Data Analytics Investigations Training Legislative Advocacy Public Awareness PRIORITIES • MEDICAL FRAUD • COMMERCIAL FRAUD • VEHICLE CRIMES FBI’s Uniform Crime Report - 2008 Vehicle Recoveries Member Company Vehicle Recoveries 25,000 Vehicles 20,000 20,355 18,643 17,628 15,000 10,007 10,000 5,000 0 2006 2007 2008 2009 1st half - 2009 Major Medical Fraud Task Forces • Florida - 2002 • New York - 2002 • California (Los Angeles) - 2007 • Texas (Houston) - 2007 • D.C. - 2008 Major Medical Fraud Task Forces What do they do? • Collect and analyze questionable medical fraud claims • Disseminate strategic and tactical alerts to NICB members • Joint investigations • Support prosecutive efforts • Seek license sanctioning actions by state regulatory agencies Place text, bullets, photos, etc., here beneath line Medical Fraud 1,600 1,430 1,400 1,200 1,191 1,046 1,000 800 600 474 562 436 400 200 0 2007 2008 2009 1st half - 2009 Medical Fraud Investigations Medical Related Prosecutions Medical Fraud • Major Medical Fraud Task Forces • Consortium to Combat Medical Fraud - NICB / National Health Care Anti-Fraud Association (NHCAA) / Coalition Agreement with P&C and Health Carriers • NICB / NHCAA Information Sharing Agreement - Crossover Analysis • Agreement with Mitchell Medical / HCI • Meeting with Congressional leaders • Results: Enhanced efforts to fight fraud! Commercial Fraud 1200 1,086 969 1000 1,111 1,056 925 800 671 592 600 Commercial Fraud Related Cases Commercial Fraud Related Prosecutions 466 400 200 0 2006 2007 2008 2009 1st half - 2009 Workers’ Compensation Stealing your “Medical ID” and Healthcare or Workers’ Compensation Benefits • International criminal enterprise run out of Dubai, United Emirates • Stole thousands of American’s medical identities • Submitted fraudulent workers’ compensation medical service bills to 70 different insurers • 19 phantom diagnostic clinics billed for $11.1 million in false services - $6 million was paid - $5.1 million was stopped prior to being paid Commercial Fraud Slip and Fall Investigation Activity: • 70 Total Active Cases in 2008 • 530 Total Claims Associated in 2008 • Repeat Offender List • Increase in Member Company Requests - Big Box – Self-Insured’s Claims not in ISO Commercial Fraud 2009 Heavy Equipment: • National Equipment Registry (NER) • 670 Units Recovered • $13 Million Estimated Value • Established direct link with Caterpillar’s database • Continue to approach other manufacturers - John Deere - Bobcat - Case-New Holland Commercial Fraud Heavy Equipment Recoveries: Units Recovered Estimated Value 2006: 527 $13,663,188 2007: 589 $15,871,129 2008: 749 $20,832,481 2009: 670 $13 Million 1st half - 2009 Commercial Fraud 2009 Cargo Theft: • 39 Loads Recovered • $5.7 Million Estimated Value • Insurance Company Recoveries Total: $2.2 Million • Co-Chair the National Commercial Vehicle and Cargo Theft Task Force (with Sheriff Ed Dean, Marion County, Florida) • Partnering with ISO to design a service that will improve information sharing between insurers, transportation companies and law enforcement Cargo Theft • Joint Investigation • Engaged Source of FBI • Crews being sent to hit warehouses • Able to track stolen goods and recover Commercial Fraud Boat Manufacturer Data: • Collaboration between various boat associations • Assist law enforcement and NICB in vessel identification and investigating insurance fraud • Memorandum of Understanding with the National Marine Manufacturers Association (NMMA) - Represents 1,400 companies - NMMA will encourage its members to report data to NICB - NICB and law enforcement will have access to the Boat Manufacturer Data - Insurance companies will have access to an indicator if boat was manufactured Commercial Fraud Boat Manufacturer Data: • Data Fields to be Reported - HIN Number - Model - Length - Hull Material - Propulsion - Boat Type - Hidden HIN Location Legislative Advocacy • National Government Affairs Blueprint - Single legislative advocacy agenda - NICB, Coalition, IASIU, State Fraud Bureaus, Trade Groups • Federal Issues - National Titling Information System - National Health Care Reform - Cash for Clunkers • State Issues - Immunity Fraud Prevention Laws Runner/Capper Statutes Restriction on access to police reports Dedicated prosecutors Health Care Reform (HCR) • Offer anti-fraud assistance to Congressional Staff through visits as they write HCR legislation: - Senator Ted Kennedy’s Staff: February 23rd - Senators Max Baucus / Arlen Specter’s Staffs: March 11th - Senators Kennedy & Specter’s Staffs, HHS/OIG, DOJ, HELP, AHIP, Finance and Aging, BCBS – April 15th • Strong interest expressed by all staffs . . . requested recommendations • Recommendations forwarded on March 26th - Approved by NICB Executive Committee and the Coalition Board - NHCAA Board prepared separate White Paper Public Awareness 1.800.TEL-NICB www.nicb.org Opportunistic Fraud NICB Analysis – 1st half 2008 vs. 1st half 2009 • Suspicious Vehicle Fires/Arsons: + 20% • Owner Give-ups: + 15% • Slip and Falls: + 51% • Workers’ Compensation: + 100% • Hail Damage: + 135% NICB Reports Hot Spots 10 year snap shot by state on vehicle thefts Hot Wheels Hot Colors – most popular colors stolen Cold Wheels – Least stolen vehicles Compare vehicle thefts with production figures Model Year/Calendar Year Vehicle theft report Top Ten Luxury Vehicle Thefts - National and by state Disaster fraud Motorcycle Theft - National and state stats Boat Theft - National and state stats Medical Fraud Hot Spots Questionable Claims Report - national and state stats Owner Give-ups Arson state by state Workers Comp/Slip and falls Heavy Equipment Theft - state stats - joint with NER Hotline Successes Exports Stats - vehicle exports by port Body Shop Fraud - Top 10 cities where this occurs/state stats Glass Fraud - state stats Staged Accidents - state stats