Insurance Fraud Investigation: 2-Day Workshop

By: Robert K Minniti, President and Owner of Minniti CPA, LLC
Location :- San Francisco, CA | Thursday, February 18, 2016 | Friday, February 19, 2016
“Insurance Fraud Investigation” – This course is approved by NASBA (National Association of State Boards of Accountancy). Seminar attendees are eligible for 16 CPE credits upon completion of this workshop.

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Course Description:

This course will cover the issues associated with insurance fraud. Examples of various types of insurance fraud, including application frauds and claims frauds will be presented. We will also discuss frauds committed by insurance agents and companies. Participants will have the opportunity to review the red flags that could be an indicator of insurance fraud. The procedures for conducting an insurance fraud investigation will be discussed and the legal issues will be examined. We will discuss strategies for preparing both civil and criminal insurance fraud cases. We will also discuss internal controls and procedures that could help to prevent or detect insurance fraud. We will review federal and state insurance fraud laws. Case studies will be presented to allow the participants to practice the skills learned in the seminar.

Learning Objectives:

  • Understanding the basics of insurance fraud
    • Application Fraud
    • Claims Fraud
    • Agent Fraud
  • Identifying Red flags that could indicate insurance fraud
  • Conducting Fraud Investigations
    • Preparing for a civil case
    • Preparing for a criminal case
  • Designing internal controls to prevent and detect insurance fraud

Areas Covered in the Seminar:

  • Internal controls designed to prevent insurance fraud
  • Internal controls designed to detect insurance fraud
  • Insurance application fraud
  • Insurance agent fraud
  • Insurance claims fraud
  • Insurance fraud investigations for civil and criminal cases
  • Legal issues in insurance fraud investigations
  • The red flags that could indicate insurance fraud
  • Federal and state insurance fraud laws

Who will Benefit:

  • Professions in insurance industry:
    • CEOs, CFOs, COOs
    • Claims adjustors
    • Managers and staff
    • Supervisors
    • Personnel responsible for issuing or approving insurance policies or claims.
  • Accounting professionals:
    • Certified Public Accountants
    • Certified Fraud Examiners
    • Internal Auditors
    • External Auditors
    • Controllers
    • Accounting Managers who work for or with insurance companies

Additionally, individuals managing or supervising insurance agents, including HR personnel, would benefit from this course. Private investigators and attorneys who work on insurance fraud cases would also benefit from taking this course.

CPE-GRC

We are registered with and adhere to the Statement on Standards for Continuing Professional Education programs of the National Registry of CPE Sponsors. Our registration number is 109066. Please check with the governing body of your license and state for specific CPE requirements. Grievances may be forwarded to the company at 650 620 3961. Grievances may also be forwarded to the National Registry of CPE Sponsors-NASBA, 150 Fourth Avenue North, Suite 700, Nashville, TN 37219-2417, 615-880-4200, www.learningmarket.org, e-mail cpe@nasba.org.

Field of Study:
  • Business Law: 1 CPE Credits
  • Finance: 7 CPE Credits
  • Management Advisory Services: 1 CPE Credits
  • Specialized Knowledge and Applications: 7 CPE Credits

Program Delivery Method: Group-Live
Program Level: Intermediate
Advance Preparation/Program Prerequisites: None

Course Outline

Day One (8:30 AM – 4:30 PM)
  • 8:30 – 9:00 AM: Registration
  • 9:00 AM: Session Start Time
  • The Overview of Insurance Fraud
    • The definition of fraud
      • Civil definition of fraud
      • Criminal definition of fraud
    • The fraud triangle
    • The elements of fraud
    • To sustain a claim of fraud, insurer was required to plead and prove each of the nine elements of fraud: (1) a representation; (2) falsity of the representation; (3) materiality of the representation; (4) speaker’s knowledge of the falsity of the representation; (5) the speaker’s intent it should be relied upon; (6) the hearer’s ignorance of the falsity of the representation; (7) the hearer’s reliance on the representation; (8) the hearer’s right to rely on the representation; and (9) the hearer’s consequent and proximate injury caused by reliance on the representation.
    • Why people commit fraud
  • Types of insurance fraud
    • Insurance application frauds
    • When a claimant attempts to obtain some benefit or advantage to which they are not otherwise entitled, or when an insurer knowingly denies some benefit that is due. According to the United States Federal Bureau of Investigation the most common schemes include: Premium Diversion, Fee Churning, Asset Diversion, and Workers Compensation Fraud. The perpetrators in these schemes can be both insurance company employees, insurance agents and claimants
    • Insurance claims frauds
    • Insurance agent frauds
      • Ways insurance agents can misappropriate funds:
        • Lapping
        • Skimming
        • Fictitious Policies
        • Forgery
        • Churning
        • False Claims
        • False applications
  • The red flags that could be indicators of insurance fraud
  • Designing internal controls to help prevent insurance fraud
  • Designing internal controls to help detect insurance fraud
  • California insurance laws and regulations
Day Two (8:30 AM – 4:30 PM)
  • Insurance fraud investigations
    • Starting an insurance fraud investigation
      • Interviewing techniques
      • Legal systems
      • Multi-media research
      • Surveillance equipment and methods
      • Crime scene investigation
    • Supervising an insurance fraud investigation
    • Managing insurance fraud investigations
    • Legal issues in insurance fraud investigations
      1. Introduction
      2. Evidence of Other Incidents
      3. Hearsay
      4. Using Experts in Fraud Cases
      5. Discovery and Privilege
      6. Constitutional Issues
      7. Criminal Proceedings
    • Investigating a civil insurance fraud case
      • Working with private investigators
      • Working with fraud investigators
      • Working with attorneys
        1. Introduction
        2. The Policy as Contract
        3. Parties to the Insurance Contract
        4. Insurer's Duties
        5. Policy Conditions
        6. Remedies
        7. Criminal Actions
    • Investigating a criminal insurance fraud case
      • Working with law enforcement
      • Working with prosecutors
    • Considering settlements
    • Alternative dispute resolution methods

Meet Your Instructor

Robert_Minniti_90_112
Robert K Minniti
President and Owner of Minniti CPA, LLC

Robert K Minniti (Bob) is the President and Owner of Minniti CPA, LLC. Bob is a Certified Public Accountant, Certified Forensic Accountant, Certified Fraud Examiner, Certified Valuation Analyst, Certified in Financial Forensics, and Chartered Global Management Accountant. Bob is currently pursuing a doctoral degree in business administration at Walden University. Bob received his MBA degree and Graduate Certificate in Accounting from DeVry University’s Keller Graduate School of Management, and received his Bachelor of Science in Business Administration degree from the University of Phoenix. Bob is a professor teaching graduate level courses in accounting, fraud examination, fraud criminology, ethics, forensic accounting, external audit, internal audit, tax, and real estate finance at DeVry University, Grand Canyon University, Northwestern University, and the University of Phoenix. He has designed graduate and undergraduate courses for Grand Canyon University, Northwestern University, and Anthem College. He is a writer and public speaker. He has experience in forensic accounting, fraud examinations, financial audits, internal audits, compliance audits, real estate valuations, business valuations, real estate financing, internal control development, business continuation planning, risk management, financial forecasting and Sarbanes-Oxley compliance work. Bob is an instructor teaching continuing professional education classes for the American Institute of Certified Public Accountants.

Bob served on the American Board of Forensic Accounting for 5 years the final two years as Chairman of the Board. He also served on the Board of the American College of Forensic Examiners for two years.

Location :
San Francisco, CA (Venue to be announced shortly)

February 18-19, 2016
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Written cancellations through fax or email (from the person who has registered for this conference) received at least 10 calendar days prior to the start date of the event will receive a refund — less a $200 administration fee. No cancellations will be accepted — nor refunds issued — within 10 calendar days from the start date of the event.

On request by email or fax (before the seminar) a credit for the amount paid minus administration fees ($200) will be transferred to any future GRC Seminars event and a credit note will be issued.

Substitutions may be made at any time. No-shows will be charged the full amount.

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