The following is part of our ongoing Case Closed series, where we highlight specific cases that we investigated and saw through to the conviction and sentencing process. Our goal is to see cases closed and fraud put an end to, which is why we see these cases all the way to the end.
In the world of insurance claims, medical assessments, and disability cases, malingering is a very important factor to consider. Being able to identify malingering is a critically important skill, especially for a Special Investigations Unit (SIU).
There are many instances within a corporate entity where allegations of fraud, misconduct and other crimes must be investigated. In order to keep the investigation private, confidential and unbiased, soliciting the services of a third party is warranted.
When Jeff Schneider started as the Senior Manager of Liability in 2011 at a large Southeast grocery store chain, the company was suffering from an excessive amount of fraud, along with the financial costs associated with that fraud. Fraud is a crime that has a cost born by everyone, including both the company and its customers. He knew that the stores were losing money, and were being forced to pass some of those costs on to the consumer. It was a problem that needed to be addressed, and quickly. Schneider chose to bring the Brumell Group forward to take up the task.
On October 15, 2010, the claimant, Gina Marie Cruz, allegedly suffered an injury to her right wrist. Four days later, she came in on crutches, claiming an injury to her ankle. Through research and a full investigation, Brumell Group learned…
Catastrophe fraud occurs when there has been a natural or man-made disaster. Those that are insured need help quickly, and insurance companies respond fast to all claims to ensure the safety and wellness of the people they cover. Catastrophe fraud comes in several forms, but essentially it means that people are taking advantage of insurance companies when a natural or man-made disaster occurs.
Do you know how much a bad hire could cost you or your company? It can be tempting for businesses to skip the background investigations in certain situations, but it is never recommended. With nearly half of resumes including some kind of discrepancy, pre-employment screenings are vital for any business that values security, capital and morale.
Fraud is a crime that is more costly than most people realize. According to the FBI, non-healthcare related fraud alone is estimated to cost the U.S. over $40 billion a year! Yet fraud and other unethical behavior does not happen randomly. Certain factors must be present to allow most individuals to commit these crimes.
American criminologist Donald Cressey developed a theory – known as the Fraud Triangle – that explains the factors that lead to fraud and other unethical behavior. When businesses and organizations understand the Fraud Triangle, they can more effectively combat criminal behavior that negatively impacts their operations.
Fraudulent activity has and always will be an issue in our society. These articles from Miami News date back to 1973 and prove the problem of fraud is timeless — and costly in automotive and medical insurance claims, as well as other areas of profession. Thank you to John Kruzewski for sending our way!
By definition, fraud is “a false representation of a matter of fact – whether by words or by conduct, by false or misleading allegations, or by concealment of what should have been disclosed – that deceives and is intended to deceive another so that the individual will act upon it to her or his alleged injury for benefit.” With insurance fraud costing companies billions of dollars each year, it’s necessary to have professional investigators reviewing each case for potential fraud. Claimants that abuse the system will need to be prosecuted with solid evidence collected by an investigative team.