Four Honored for Fighting Insurance Fraud

PALM DESERT, Calif., Sept. 10, 2012 /PRNewswire-USNewswire/ -- The International Association of Special Investigation Units (IASIU) presented awards today to four individuals involved in fighting insurance fraud at the 27th Annual Seminar & Expo on Insurance Fraud being held in Palm Desert, Calif.

Analyst of the Year
Mary Durden of GEICO was honored as Analyst of the Year for her work on a staged accident investigation in Georgia. She assisted the National Insurance Crime Bureau (NICB) by providing information on an individual who used fictitious names to obtain insurance policies and make claims not only from her insurance company, but from multiple insurance carriers. Many of the claims involved the same vehicle with the same damages resulting in payments being made to the fictitious named individuals. Through Durden's analysis, more than 40 claims were identified and provided to the NICB along with the summary of the claim information, photographs and estimates of the damage.

As a result of Durden's efforts, the U.S. Secret Service investigated for possible federal mail fraud, wire fraud or bank fraud violations. That investigation led the individual to confess to submitting fraudulent insurance claims.

Investigator of the Year
John Boatwright of Travelers Insurance received the 2012 Investigator of the Year Award for his work that exposed a California-based durable medical equipment (DME) company that was improperly increasing payments for medical equipment. His investigation showed the company was billing for expensive pieces of DME while delivering sub-standard models; providing altered source documents to substantiate the cost of certain pieces of equipment; utilizing the state's lien process to further their enterprise; and altering medical bills to test and deceive payment systems

As a result of the investigation, the insurer sought litigation through the California False Claims Act in late 2011 and the case was settled this year.

Public Service Award
Wendy Derzaph of the Los Angeles County District Attorney's Office received the 2012 Public Service Award for her efforts in prosecuting a large, sophisticated, international insurance fraud criminal enterprise being run out of Dubai in the United Arab Emirates. 

The crime ring consisted of 11 primary suspects from around the globe who stole thousands of Americans' identities and used the stolen identities to submit fraudulent workers' compensation medical service bills to 70 different insurance companies. Through the scheme, this group illegally obtained millions of dollars in fraudulent insurance payments, and then laundered the proceeds through wire transfers to Dubai, Armenia, or the Philippines. 

A total of 55 felony counts were filed against each of the 11 defendants alleging insurance fraud, grand theft, identity theft, money laundering, and conspiracy. Derzaph concluded the case with six of the defendants entering guilty pleas in court and international arrest warrants being issued for the other five defendants. The court also ordered $4.8 million in restitution. 

Outstanding Service Award
Walter Swett, of Nationwide Insurance and the Georgia IASIU chapter, was honored for more than a decade of service to the national and local organizations. In addition to serving on the National Board of Directors, under his leadership, the Georgia chapter grew its regular and associate membership numbers to a steady annual roster of around 100.

Swett also paved the way for educating local and state law enforcement agencies about all facets of insurance fraud – creating an entire training program for law enforcement agencies on various aspects of insurance fraud investigation and prosecution. Recently, he led the chapter's public anti-fraud education campaign – utilizing billboards throughout the state to urge the public to call the NICB's 1-800-TEL-NICB hotline to report insurance fraud.

About IASIU:  The International Association of Special Investigation Units has thousands of members that include insurance fraud investigators, NICB agents, other insurance professionals and members of law enforcement. The group provides fraud awareness training to its members; promotes a coordinated effort within the insurance industry to combat insurance fraud; supports legislation that acts as a deterrent to the crime of insurance fraud; and develops a greater awareness of the insurance fraud problem within the industry. For more information, visit www.iasiu.org.

About the National Insurance Crime Bureau:  headquartered in Des Plaines, Ill., the NICB is the nation's leading not-for-profit organization exclusively dedicated to preventing, detecting and defeating insurance fraud and vehicle theft through data analytics, investigations, training, legislative advocacy and public awareness.  The NICB is supported by more than 1,100 property and casualty insurance companies and self-insured organizations.  NICB member companies wrote over $339 billion in insurance premiums in 2011, or approximately 80 percent of the nation's property/casualty insurance.  That includes more than 94 percent ($156 billion) of the nation's personal auto insurance.  To learn more visit www.nicb.org.

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SOURCE National Insurance Crime Bureau