Download or read book The Claim Game written by Mario S. Pecoraro and published by iUniverse. This book was released on 2015-10-08 with total page 97 pages. Available in PDF, EPUB and Kindle. Book excerpt: Organizations that fail to identify and eliminate fraud are losing hundreds of thousands of dollarsand many dont even know it! Many claims professionals dont have the time or resources to spot the red flags that indicate a fraudulent workers compensation claim, and even if they stumble upon one by chance, they fail to conduct a comprehensive investigation. Mario S. Pecoraro, CEO of Alliance Worldwide Investigative Group, provides proactive strategies that will save you resources, money, and time investigating claims. The twenty best practices he explores will help you: hire the type of employee who wont file a claim in the first place; engage in preventative maintenance throughout the life of a claim; determine who should conduct an investigation when a claim is filed; carry out the investigative process using a variety of tools. Filled with case studies demonstrating where investigations went wrong (and where they went right), youll be equipped to apply best practices and avoid common mistakes. Start saving money, and get the right team in place with The Claim Game.
Download or read book The Auto Policy and The Claim Investigation Process written by Hector Quiroga and published by Lulu.com. This book was released on with total page 187 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Model Rules of Professional Conduct written by American Bar Association. House of Delegates and published by American Bar Association. This book was released on 2007 with total page 216 pages. Available in PDF, EPUB and Kindle. Book excerpt: The Model Rules of Professional Conduct provides an up-to-date resource for information on legal ethics. Federal, state and local courts in all jurisdictions look to the Rules for guidance in solving lawyer malpractice cases, disciplinary actions, disqualification issues, sanctions questions and much more. In this volume, black-letter Rules of Professional Conduct are followed by numbered Comments that explain each Rule's purpose and provide suggestions for its practical application. The Rules will help you identify proper conduct in a variety of given situations, review those instances where discretionary action is possible, and define the nature of the relationship between you and your clients, colleagues and the courts.
Download or read book Medical Malpractice Claims Investigation written by Nancy Acerbo-Kozuchowski and published by Jones & Bartlett Learning. This book was released on 1997 with total page 298 pages. Available in PDF, EPUB and Kindle. Book excerpt: The book is designed as a primer for claims investigators, health care managers, QA/QI personnel, in-house counsel, paralegals, personal injury attorneys, and others whose duties include the investigation of actual and potential medical malpractice lawsuits. It can be used as a desktop reference, self-study guide, or as part of a formal orientation program for risk managers and quality assurance personnel. The book contains a step-by-step description of the claims investigation. It also provides instruction on reviewing medical records; identifying adverse patient occurrences; selecting, locating and interviewing personnel involved in occurrences; analyzing investigative findings; and writing the investigation report.
Download or read book The Investigation of Freight Claims written by George Henry Hunt and published by . This book was released on 1920 with total page 90 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Healthcare Fraud Investigation Guidebook written by Charles E. Piper and published by Taylor & Francis. This book was released on 2017-07-27 with total page 172 pages. Available in PDF, EPUB and Kindle. Book excerpt: Some have estimated that healthcare fraud in the United States results in losses of approximately $80 billion a year. Although there are many books available that describe how to detect healthcare fraud, few address what must be done after the fraud is detected. Filling this need, Charles Piper‘s Healthcare Fraud Investigation Guidebook details not only how to detect healthcare fraud, but also how to investigate and prove the wrongdoing to increase the likelihood of successful prosecution in court.The book starts by covering the history of healthcare insurance and the various types of fraud schemes. It presents Charles Piper‘s unique approach to investigating (The Piper Method) which allows readers to conduct as many as 10 simultaneous investigations for each case. It emphasizes the importance of simultaneously searching for waste and abuse as well as systemic weaknesses and deficiencies that caused or contributed to the problem or wrongdoing under investigation and then make recommendations for improvement. It also provides:Questions to ask whistleblowers, complainants, employers, employees, and healthcare providers who are suspectsTips on investigative case planning, goals, and strategiesSample visual aids for use when briefing others about your investigative findingsGuidance on presenting information obtained from healthcare investigations and on how to testify in courtTechniques for uncovering previously undetected fraudThe book includes a sample case study that walks readers through a mock case from the time the case is received through the end. The case study demonstrates how to initiate, plan, and conduct a thorough and complete healthcare fraud investigation while incorporating Piper‘s proven methodology.Sharing insights gained through Charles Piper‘s decades o
Download or read book Insurance Claims Investigation and Agency Practice written by William Merrell and published by . This book was released on 1998-06-01 with total page 201 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Understand Insurance Fraud written by Adolfo Bulleri and published by Independently Published. This book was released on 2021-05-15 with total page 182 pages. Available in PDF, EPUB and Kindle. Book excerpt: An insurance fraud investigation is a type of fraud investigation that centers around attempts to benefit from deceitful claims. Seeking compensation for false or inflated claims is illegal, dangerous, and raises the price of insurance for everyone. An insurance fraud investigation aids by revealing false claims. Don't let your insurance premiums be a waste of money; use a private investigator to safeguard your insurance privileges. Here's a fascinating-often-time hilarious compilation of insurance fraud cases, some so outrageous, so utterly bizarre and crazy, you'll have a hard time believing them. But it's all true-direct from the private confidential files of one of the nation's top investigators. It represents the best of the best cases the author has handled.
Download or read book The Investigation and Adjustment of Liability Insurance Claims and Workmen s Compensation Losses written by Walter Loane Clark and published by . This book was released on 1914 with total page 120 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book The Criminal Investigation Process written by Peter W. Greenwood and published by Free Press. This book was released on 1977 with total page 360 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book United States Attorneys Manual written by United States. Department of Justice and published by . This book was released on 1988 with total page pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Crime Scene Investigation written by National Institute of Justice (U.S.). Technical Working Group on Crime Scene Investigation and published by . This book was released on 2000 with total page 64 pages. Available in PDF, EPUB and Kindle. Book excerpt: This is a guide to recommended practices for crime scene investigation. The guide is presented in five major sections, with sub-sections as noted: (1) Arriving at the Scene: Initial Response/Prioritization of Efforts (receipt of information, safety procedures, emergency care, secure and control persons at the scene, boundaries, turn over control of the scene and brief investigator/s in charge, document actions and observations); (2) Preliminary Documentation and Evaluation of the Scene (scene assessment, "walk-through" and initial documentation); (3) Processing the Scene (team composition, contamination control, documentation and prioritize, collect, preserve, inventory, package, transport, and submit evidence); (4) Completing and Recording the Crime Scene Investigation (establish debriefing team, perform final survey, document the scene); and (5) Crime Scene Equipment (initial responding officers, investigator/evidence technician, evidence collection kits).
Download or read book Claim Investigation written by and published by . This book was released on 2015 with total page 149 pages. Available in PDF, EPUB and Kindle. Book excerpt:
Download or read book Insurance Fraud Volume II written by Barry Zalma and published by . This book was released on 2019-10-31 with total page 460 pages. Available in PDF, EPUB and Kindle. Book excerpt: Insurance Fraud Is Epidemic Insurance fraud continually takes more money each year than it did the last from the insurance buying public. There is no certain number. Most attempts at insurance fraud succeed. Estimates of the extent of insurance fraud in the United States range from $87 billion to more than $300 billion every year.Insurers and government backed pseudo-insurers can only estimate the extent they lose to fraudulent claims. Lack of sufficient investigation and prosecution of insurance criminals is endemic. Most insurance fraud criminals are not detected. Those that are detected do so because they became greedy, sloppy and unprofessional so that the attempted fraud becomes so obvious it cannot be ignored.The National Insurance Crime Bureau (NICB) estimates that almost 25% of the bodily injury claims related to auto crashes are bogus. Property and casualty claims against auto insurance are not much better, coming in at around a 10% fraud rate.A person commits the offense of insurance fraud by knowingly and with the intent to defraud any insurer presents or causes to be presented to any insurer any statement forming a part of, or in support of, a claim that contains any false, incomplete or misleading information concerning any fact or thing material to the claim. [18 Pa.C.S.A. § 4117(a)(2).] A person acts "knowingly" when he or she is aware that it is practically certain that his or her conduct will cause such a result. Likewise, a person acts "intentionally" when "it is his or her conscious object to engage in conduct of that nature or to cause such a result.As the industry attempts to keep pace with fraudsters' varied, ever-shifting tactics, it must deploy more innovative, effective anti-fraud technologies or risk dire losses. Vendors and organizations include the Coalition Against Insurance Fraud (CAIF), CSC, Detica NetReveal, Equifax, Experian, FICO, IBM, Innovation Group, Insurance Bureau of Canada (IBC), ISO/Verisk, KPMG, LexisNexis, Mattersight, Mitchell, the National Insurance Crime Bureau (NICB), SAP, SAS, and TransUnion.Insurers must also generate a close relationship with the state insurance department's fraud division or fraud bureau, local police agencies, the FBI, the ATF, the Postal Investigation Service, the local fire department's arson unit, local prosecutors, and the local U.S. Attorneys if they are to have any chance to reduce the effect of insurance fraud. Insurers should also work to make the general public, state legislators, state governors, congress members and U.S. Senators, and the Attorney General of the United States aware of the effect insurance fraud has on the public at large and the insurance industry.Wherever insurance is written insurance fraud exists. It is an equal opportunity fraud committed by people of every race, religion or national origin. Insurers who do not exercise serious anti-fraud efforts often complain that the local district attorneys and police agencies give a low priority to the crime of insurance fraud. No matter how seriously the insurers work to prove fraud the authorities often ignore them. In response, police and prosecutors complain that the insurers do nothing that police and prosecutors can use to prosecute the crime of insurance fraud while insurers complain that prosecutors ignore them when they present evidence of a fraud. There is truth in both complaints. Insurers, although compelled by statute to investigate potential insurance fraud and to present the results of their investigations to prosecutors, they are not trained as police officers. This book is written to make it clear to insurers, police and prosecutors that it is necessary to stop complaining and start working together to reduce the extent of insurance fraud. If they do not work together the crime will continue to metastasize until it will be impossible to write insurance at a profit or for a price anyone can afford.
Download or read book The Investigation and Adjustment of Liability Insurance Claims and Workmen s Compensation Losses written by Walter Loane Clark and published by Theclassics.Us. This book was released on 2013-09 with total page 26 pages. Available in PDF, EPUB and Kindle. Book excerpt: This historic book may have numerous typos and missing text. Purchasers can usually download a free scanned copy of the original book (without typos) from the publisher. Not indexed. Not illustrated. 1914 edition. Excerpt: ... Chapter VII. PHYSICIANS' LIABILITY INSURANCE PHYSICIANS' LIABILITY: Policies of this character have become a great necessity to all classes of physicians on account of the prevalence of suits for malpractice. Such actions are often brought to avoid payment for services rendered, sometimes for purposes of blackmail, and occasionally they are fostered through professional jealousy or enmity. The defense policy contemplates only the payment of counsel and witness fees and the management of the litigation, including investigation, advice and negotiations for settlement. The liability policy includes, in addition to such defense, the payment to the assured of the amount of any verdict, which he may be compelled to pay out on account of any alleged malpractice. The hazard insured against is the consequence of a civil suit for "malpractice" on account of bodily injuries, or death resulting from some alleged error on the part of the assured or his assistant. Prompt notice of all claims must be given so that a successful defense or favorable adjustment may be effected. Settlements may be made only with the consent of the assured, thus enabling him to insist upon a vindication if he deems it best. Ascertain whether the claim falls within the terms of the policy, particularly as to the date of the alleged treatment, the sobriety of the assured or his assistant, as well as compliance with the policy conditions. If suit has been instituted, arrangements should be made to prevent default until the investigation can be completed. No physician guarantees the success of his treatment, whether it be medical or surgical, and no presumption of carelessness arises from failure alone. Physicians are legally bound to place at the service of their patients a...
Download or read book Red Handed written by Jr Robles and published by Lioncrest Publishing. This book was released on 2018-06-20 with total page 242 pages. Available in PDF, EPUB and Kindle. Book excerpt: Obtaining key facts of the claims process while staying current on laws impacting workers' compensation claims takes time, effort, and the right partners. But claims examiners are often inundated with more than one hundred active claims, while claims managers, risk managers, and VPs are removed from the day-to-day hurdles of the process. All of these stakeholders need a way to manage claims effectively while staying on top of industry-related developments, with less hazard and expense. Red-Handed is the claims examiner's bible to understanding claimant insurance fraud. With up to-date information on best practices, workers' comp insurance expert JR Robles reveals how to conduct an effective investigation by using background checks, social media, and surveillance without running afoul of the legal system; understanding current case law; reducing the opportunity for fraud; and more. Knowledge is power. If you're an insurance professional or human resources manager, Red-Handed will help you lower the costs and risks associated with workers' comp claims.
Download or read book Medical Malpractice Claims Investigation A Step by Step Approach written by Nancy Acerbo-Kozuchowski and published by Jones & Bartlett Learning. This book was released on 2006-10-25 with total page 0 pages. Available in PDF, EPUB and Kindle. Book excerpt: This manual describes all the steps necessary to undertake and complete a thorough medical malpractice investigation. It is a comprehensive, step-by-step guide to the elements involved in the investigation of an actual or potential medical malpractice claim, and covers the process of reviewing medical records, other document collection, fact analysis, interviewing involved individuals, and identifying possible departures from accepted medical practice. The new second edition of Medical Malpractice Claims Investigation: A Step-by-Step Approach features a complete revision of chapter five (Developing Interview Questions), additional material on new JCAHO requirements, electronic medical records, office-based surgery issues, and long-term care claims investigation.
