Deceit & Fraud Detection Strategies

Transcription

1 Deceit & Fraud Detection Strategies Monday, July 13, p.m. STANDER, REUBENS, THOMAS & KINSEY Ted Richards, Attorney, Certified Specialist WC Law PROBE INFORMATION SERVICES, INC. Dalene Bartholomew, CFE, CIFI, Vice President 1

2 2

3 3

4 When do people lie most often? Phone In person Extroverts vs. Introverts Men vs. Women Co Workers vs. Strangers 4

5 5

6 Contractions did not vs. didn t Distancing language that woman Categorical vs. Specific Denial Broad denials associated with honesty Narrow denials associated with deception Common Lie Denial of Prior Medical Treatment 6

7 54 year old mechanic alleged industrial injury to knee Co worker provided tip Trigger for Investigation Medical Canvass found injury occurred non industrially 7

8 * how to tell if your dog is involved in a sex scandal 8

9 Exaggerated Gestures Covering Mouth 9

10 Manipulators HAPPINESS SURPRISE CONTEMPT DISGUST FEAR SADNESS ANGER 10

11 Recognize signs of deceit & trust your instincts Indicators, tips or rumors = more info needed Neutral investigations, not interrogations Open ended questions and active listening 11

12 Long term Employee Accepted WC Claim CT Release Surgery Alleged no use of hands Extended TTD Tips from co workers Surveillance warranted 12

13 Q: Can you hold a coffee cup? A: Nothing heavy. Q: So can you pick up and hold a coffee cup? A: No. I can t even hold a pencil. Q: Is that because of the pain? A: Yes. Too much pain. 13

14 Q: Can you drive? A: It is dangerous for me to drive. Q: Do you drive? A: When I have to drive. Q: Can you operate a remote control? A: No. Q: Does pain medication help you? A: Not really. Q: Can you use either of your hands if you take pain medication? A: No. My hands are not good anymore. 14

15 AME Ortho Surgeon Arrested 12 Felony Counts of Fraud for lying to medical providers and in deposition 15

16 16

17 Press Releases Provides deterrence & cultural impact 17

18 18

19 Details events leading up to the injury but lacking info about the injury as far as I can recall what I remember is. 19

20 Liars overemphasize their truthfulness To be honest To tell you the truth I swear DATA UTILIZATION TO DETECT DECEIT 20

21 STATEMENTS Secure statements as soon as possible Lock down details before body parts added or retains attorney Learn insight from witnesses 21

22 Acknowledged requirement to report income Denied working or earning income Wages, cash, trade, volunteer, barter, independent employee, self employment Denied ability to drive; even with pain meds Laughed nervously during interview 22

23 STOPPED UNWARRANTED BENEFITS 23

24 Return Malingerers to Work 24

25 Stop Unwarranted Medical Treatment Appropriate Permanent Disability 25

26 Appropriate Settlement Value Stop Abuse and Fraud 26

27 BACKGROUND & SOCIAL MEDIA Substantiate validity of claims Insight into lifestyle, character & activities Key for deposition preparation Share with medical providers; WCAC & Court Name, SSN, DOB, verification Business & Professional Licenses Civil Criminal Courts DMV, Prior Accidents, DUI Addresses Cohabitants Relatives Financials Assets Liabilities Bankruptcy Tax Liens Judgements License Plate History BACKGROUND DATA Provides important insight into subject Can identify motivation for deception National Database National Public Records Federal, state, county, local + DMV records 100+ government lists 27

28 SOCIAL MEDIA DATA Document activity Provides evidence of truthfulness or deception Used at WCAB, medical providers & Court Obtain legally verifiable Captures metadata log for chain of evidence testify to authenticity 28

29 Identify Personal Biases Believe those like us & distrust those different Trust charismatic, attractive, in group people See consistency with what be believe to be true Predisposed to see what is in our best interest 29

30 30

31 STANDER, REUBENS, THOMAS & KINSEY Ted Richards, Attorney at Law law.com PROBE INFORMATION SERVICES Dalene Bartholomew, CFE, CIFI, VP