The Cost of Insurance Fraud
Insurance fraud costs US companies billions of dollars a year, making it difficult for insurance providers to continue offering the coverage that Americans need without significantly increasing policy premiums. There is a fiduciary duty to identify, report & combat insurance fraud. In fact, many states mandate that insurance companies have Special Investigative Units (SIUs) to develop and implement anti-fraud services and minimize risks. Insurance companies can be fined if not compliant with state requirements.
How Brumell Group Helps Combat Fraud
Brumell Group offers full-service SIU management and compliance services to insurance providers nationwide. We’ll begin with a thorough assessment of your company’s operations, policies and procedures to identify all strengths and weaknesses in your anti-fraud efforts. Then, we’ll develop and file an anti-fraud plan, or implement and maintain SIU management practices over the long term, and assure that your company remains in compliance with all relevant state statutes.
Fully Customizable SIU Management & Compliance Services
Brumell Group’s customized anti-fraud plan for your company can include any or all of the following:
- Annual reporting to state
- Development and submission of comprehensive anti-fraud plans
- Review, identification and detection of potentially fraudulent claims (Case Analysis™)
- Evaluate, Detect, Investigate and Report for investigation of such claims (Case Analysis™)
- Full claims investigative services
- Systematic tracking of the progress and results of reported claims for the purpose of periodically updating action plans and annual reporting
- Reporting claims with suspicion of fraudulent acts to your state’s Division of Insurance Fraud
- Assisting in prosecution of claims determined to be fraudulent
- State-certified continued education unit(s) training
- Toll-free fraud hotline
- Vendor Management
How Case Analysis™ Works
A Case Analysis™ is a unique service for Adjusters and Litigation Specialists. Conducted by a Cert0ified Fraud Examiner, a Case Analysis™ reviews all documents and information related to a claim to evaluate and detect “Red Flag” indicators of fraud. A comprehensive report detailing this evidence is completed and presented with recommendations on how to proceed with the claim. The review may identify that additional investigations are needed, or it may identify that enough evidence exists to present the claim as-is to the law enforcement authorities for possible prosecution. Often a claim can be successfully denied simply based on the “Fraud Defense” identified in the Case Analysis™ Report. Our Case Analysis™ has proven to save valuable time and resources for our clients when determining the validity of a claim.
SIU VENDOR MANAGEMENT Services
Some clients may have already established a valued relationship with an investigations company for specific regions, for this purpose, Brumell Group has established a vendor management program which allows clients to continue those relationships while maintaining our high standards in investigation protocols, licensing, liability insurance, and ethics. The operational benefits of utilizing Brumell Group’s Vendor Management Program:
- Maintain existing relationships with current vendors/service providers, while utilizing Brumell Group’s investigations personnel to supplement in geographic areas not currently covered by current vendor/service provider.
- Ensure consistency for every investigation conducted, regardless if completed by another service provider or by Brumell Group.
- Complete vetting process to ensure all service providers maintain Brumell Group’s high standards; each service provider is required to be under contract which states their agreement to rates, investigations protocols, licensing, liability insurance, and Brumell Group’s code of ethics.