Insurance Fraud Investigation

• 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

• 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

Bob Minniti 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, Master Analyst in Financial Forensics and a Chartered Global Management Accountant. Bob is also a private investigator licensed in the State of Arizona. 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.