|Winter 2018 Volume 28, Number 1|
How Technology Is Helping to Reduce Fraud
Fraud in all U.S. lines of insurance is responsible for approximately $80 billion per year in losses. Several billion dollars of that is workers comp fraud. In the past few years, however, some of those loses have been reduced thanks to technology.
Video and Video Surveillance:
Though the use of drones with cameras on board for investigating fraud is rapidly growing, particularly on stakeouts (see below), claims investigators use video in other ways, as this excerpt from a post on the www.trustify.info blog demonstrates:
“You wouldn’t mind if I… you know… videotaped us working out, would you?” I said to Lifter guy. “Just to look at my form and stuff?”
“No problem. You gonna put it on YouTube or something?” Lifter Guy responded.
“Yeah,” I smirked and smiled, “something like that.”
Little did Lifter Guy know that I was a Private Investigator (P.I.) working undercover to videotape him powerlifting while cheating the workers’ compensation system.
People like attention, so it’s not hard to get their permission to film them even in situations where they should be more cautious. A more common use of video is as a surveillance tool.
Prescription Monitoring Database
Almost every state uses a prescription drug monitoring program to control substance abuse. These databases track drug use by patients as well as the dispensing of drugs by prescribers, making it easier to detect patterns of excessive or fraudulent use of opioids and other controlled substances.
A workers comp recipient was on leave because of a work-related injury. However, he “could not resist playing a contact sport on a local semi-professional sports team,” according to Risk Management Magazine. Social media and internet searches revealed the worker was listed on the team roster and having a great season.
Private investigator Mike Stanfield of Apex Investigation Group used to stake out a suspected fraudster for weeks. Now he uses technology. He recently sent a remote camera drone to make short flights near the house of someone suspected of faking a back injury. Stanfield discovered that the supposedly disabled man was “tossing around 200 pound rocks re-landscaping his property.”
Internet of Things
As we interact more and more with apps and appliances these days, we leave behind time stamped data records of our whereabouts, actions and even our conversations. That information is now being used in investigations. In Arkansas, a court order was issued to Amazon demanding Echo recordings of a suspect in a murder investigation. In Ohio prosecutors will use data from a fraud suspect’s pacemaker to attempt to prove he lied in statements to investigators about how he escaped the fire in his home.