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Uniting the fraud fight

Annual Report 2015ADVOCACY INFORMATION OUTREACH

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A formless cloud of dust hovered in dark space 4.6 billion years ago. Then gravity rose up. The dust came together, forming ever-larger particles. The clumping mass formed Planet Earth.

The forces shaping planets mirror the power of partnering against fraud. The Coalition is an alliance. We create a gravitational pull that brings people and organizations together. It’s an irreplaceable role, which unifies and amplifies the fraud fight.

The Coalition’s three pillars of membership — insurers, consumer groups and government agencies — align to help shape this mission.

The last year reflected, well, a world of partnering.

We teamed with IASIU to mount grassroots letter-writing campaigns urging stronger state fraud laws. A public-private partnership the Coalition co-founded advanced in uniting fraud fighters against medical schemes.

Gravity begets worlds greater than their individual fragments. In like manner, partnering force-multiplies the Coalition’s surge against fraud crime. That’s what makes partnering so ... universal.

Sincerely,

“If everyone is moving forward together,

then success takes care of itself.”

— Henry Ford

Don RoundsCo-chair

Don RoundsConsumer Federation at the Southeast

Frank SztukHanover Insurance

Publisher’s letter

Frank SztukCo-chair

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“They think the worst thing that can happen is that the

insurance company won’t pay the claim. No, the worst that

can happen is that they can be charged with fraud.”— San Diego County Deputy

DA John Philpott

“I’m desperately sorry for all of this. I never ever thought

I would hurt my family, my community. I-I-I can’t talk.

I’m sorry.”— Convicted workers

compensation swindler Carole J. Swan, Chelsea, Me.

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Public outreachCoalition informs tech-savvy consumers using visuals, social media

“Next to doing the right thing, the most important thing is to let people know you are doing the right thing.”

— John D. Rockefeller

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America is rewiring. Millennials are coming of age, 83-million strong. Social media are mainstream sources of news and opinions. Mobile devices are becoming a tech-savvy society’s info-sharing tools of choice.

We’re also a visual nation. Increasingly, people want fraud message using rich images and video. Call it cornea communication.

The Coalition is shaping how people view fraud by pursuing these outreach goals:

• Be visual. Tell the fraud story with rich images and video;

• Go social. Launch a constant flow of anti-fraud messages via Facebook, Twitter, Instagram and other social sites; and

• Think mobile. Make anti-fraud messages easy for people to view on smartphones, iPads and other mobile devices.

Visualizing fraud: see deterrence in new light

Infographic. “Protect your hard-earned money from insurance thieves. And steer clear of scamming — unless a jail cell seems like appealing, rent-free housing.”

So opens the Coalition’s new fraud infographic. It’s the first of its kind in America. Insurance fraud: Why Care? is edgy for youths yet right for older adults.

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At least 50 Coalition members have requested the dramatic 30-second videos to customize for their outreach efforts.

A job seeker loses a near-certain offer after admitting she had a fraud conviction.

“Man, that’s insurance fraud. That’s serious stuff,” an irate guy warns a buddy who’s about to inflate the value of a stolen TV.

Erie Insurance posted the video spots on its YouTube channel. Same with the Colorado insurance department. The Iowa-Nebraska chapter of IASIU rotates videos on its homepage.

The fraud story unspooled in high-impact graphics. 5 ways fraud stiffs you. ... 3 scams you can prevent ... 5 ways you’re toast.

Did you know highly trained arson dogs can smell things 100,000 times better than people?.

The fraud story came alive, at-a-glance. The graphic will be widely circulated to consumers. And Coalition members will adopt Why Care? for their own outreach efforts.

Video spots. A valued partnership begat the Coalition’s signature visual outreach tool — eight consumer video fraud spots. They show everyday consumers making dumb choices to bilk their insurer — or thinking about it.

A Coalition board member, the Pennsylvania Insurance Fraud Prevention Authority, gifted the videos for Coalition adoption.

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“As a united alliance, the Coalition carries unique credibility with reporters seeking authoritative insights about this crime.”

The Coalition is America’s defining voice of the fraud fight on social media. Deterrent news of fraud busts, convictions and ruined lives flowed out daily on Facebook and Twitter.

The Coalition’s social sites were constantly updated staging grounds of news, mugshots, TV shows and anti-fraud messages.

Hundreds of posted cases reminded consumers that insurance fraud is a dead-end street.

Just as important, we had real-time conversations with consumers — teachable moments all.

People asked how to report scams. Some knuckleheads bragged about their crimes — a perfect forum for Coalition rebuttal. Some people just wanted to learn about fraud. The Coalition regularly responded.

Consumer engagement — how involved they were — in more than quadrupled on Facebook and nearly doubled on Twitter over 2014. It was the fourth straight year of significant Facebook growth.

Social-media efforts grow fast in 2015

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Making fraud news, shaping views

As a united alliance, the Coalition carries unique credibility with reporters seeking authoritative insights about this crime.

News outlets of all sizes sought the Coalition for interviews to define trends and give deterrent consumer advice. Stories spanned all lines of insurance. They ranged from staged crashes to workers compensation to Medicare — 27 distinct fraud topics.

“If you have to face a suit, it can be financially draining. It makes you think

twice about defrauding an insurer.” — Boston Globe (insurers suing

staged-crash rings)

“When you’re posting your exploits in front of tens of millions of people to freely see, that’s not privacy anymore. You’ve posted your activities on your

digital front lawn.” — CBS News (social-media searches)

“The moment you get a call or email asking for your [Medicare] number by someone claiming they’re from Medicare, you’re dealing with an

automatic scam.” — U.S. News & World Report (Medicare cons)

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Fraud journal: prime field intel for leaders

Executive insight abounded in the Coalition’s quarterly flagship publication, Journal of Insurance Fraud in America.

Thought leaders brought actionable field intelligence for decisionmakers in JIFA articles. Coalition members furthered our close partnership by writing several articles.

A decisionmaker forum, JIFA defined trends that are re-shaping the fraud fight.

Why rational swindlers avoid crime when risk isn’t worth the reward ... how insurers use civil suits against staged-crash rings ... how insurers can learn from how financial services detect fraud ... why drones could be the next anti-fraud impact tool.

“Thought leaders brought actionable

field intelligence for decisionmakers in

JIFA articles...”

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Pharaohs of fraud shamed, blamed

Memo to insurance cheaters: Here’s an easy shortcut to ruining your life ... try and defraud your insurance company.

Such is the deterrent message the Insurance Fraud Hall of Shame signals to millions of consumers.

The Coalition dishonored the most-brazen or klutzy convicted criminals of 2015. People are 20 times more likely to recall stories than raw facts or data. Two highlights:

Fiery coffin. Dion and Jennifer Longworth were incinerated when their next-door neighbor Mark Leonard blew up his Indianapolis house for a $300,000 insurance payout.

His botched arson explosion leveled much of the neighborhood. At least 80 homes were damaged. Jennifer died instantly. Onrushing flames trapped Dion in his basement. Leonard received life without parole. Colossal crashes. Mikhail Zemlyansky ran one of the largest staged- crash rings in history. His criminal network lodged at least $279 million in fake injury claims from setup car wrecks. Zemlyansky’s Russian-speaking gang worked the New York City area. Crooked doctors forged medical reports. Car passengers were coached to fake injuries. Zemlyansky received 15 years in federal prison.

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“I believe in democracy because it releases the energies of

every human being.”— Woodrow Wilson

LegislationGrassroots activism helps pass fraud laws, grow impact

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“Medical mills and staged-crash rings are spreading in Minnesota. Stronger insurance fraud laws are needed to help combat these criminal enterprises.”

Auto scams being roadblocked in 3

hotbed states

Minnesota and Kentucky faced upsurges of staged-crash rings setting up operations in urban areas. Seasoned ringleaders perceived both states as soft targets for bogus injury claims.

New Jersey was dogged by instate drivers illicitly avoiding high auto premiums by lying they garaged their vehicles in lower-premium states.

The Coalition built support by proposing laws, testifying in statehouses, and writing key committee chairs and other policymakers. Joint grassroots campaigning added considerable support as all three hotspot states enacted new fraud laws.

Minnesota. The state commerce department gained authority to civilly fine fraudsters, and boot crooked medical providers from the insurance system.

The Coalition proposed those measures. Legislators adopted them into a bill that became law. “Medical mills and staged-crash rings are spreading in Minnesota. Stronger insurance fraud laws are needed to help combat these criminal enterprises,” the Coalition told a key legislative committee in testimony.

Kentucky. The Coalition also opposed scammers who try to lure crash victims into getting whiplash treatment that’s inflated, useless and fraudulently billed to insurers in Kentucky.

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Recruiters for fraud rings often showed up at crash scenes or cold-called often-dazed victims with pitches for shady medical clinics.

Lawmakers fortified a Kentucky law forbidding soliciting of victims for 30 days after the crash. The Coalition was front and center. We steadily worked to build support behind the scenes, and testified in the statehouse. The clampdown on soliciting crash victims became the law of the land in Kentucky.

New Jersey. Dodgy drivers will face stiff penalties for lying that they garage their vehicles in lower-premium states.

The Coalition firmly supported a bill making auto-rate evasion a specific crime. Faking a garaging locale defrauds insurers and penalizes honest drivers, we testified before the Senate during hearings. Gov. Chris Christie received a Coalition letter when the bill reached his desk for signature in early 2016. Christie signed the measure into law.

“The Coalition was front and center. We steadily worked to build support behind the scenes.”

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Grassroots lobbying lends vital support for

hotspot bills

Fraud fighters took more decisive steps as a grassroots lobbying strike force growing more-skilled in gaining the attention of state legislators.

The Coalition joined forces with the International Association of SIUs to launch letter-writing campaigns. Fraud fighters successfully urged “yes” votes for new anti-fraud laws in the hotbed states of Minnesota, Kentucky and New Jersey.

A salvo of support in New Jersey went to legislators debating a bill making evading auto premiums a specific crime. Fraud fighters weighed in again, urging Gov. Christie to sign after the measure cleared the state house. It was the first time investigators had petitioned a governor.

IASIU members also urged passage of three anti-fraud provisions in Minnesota. More rounds of letters sought to greatly limit soliciting of crash victims for potentially false injury treatment in Kentucky.

At least 120 fraud fighters backed a similar measure in New York, though that bill stalled.

Letter-writing campaigns in four states, new fraud laws in three.

The successes reflected the Coalition’s growing partnership with IASIU.

“It was the first time investigators had petitioned a governor.”

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Deflating airbag cons with Honda America

Repair shops make good money installing cheap knockoffs then billing insurers full freight for expensive manufacturer versions. Motorist lives are on the line — knockoffs typically don’t inflate properly in a crash.

Marketing and installing counterfeit airbags must be a specific crime with stiff penalties. That was the message the Coalition and Honda America jointly pursued in hotspot states.

New Jersey, New Mexico and Iowa made airbag scamming a specific crime last year.

States are awaking to the need to thwart dangerous airbag scams. Ten states have booked similar airbag-fraud laws since 2013.

Advising national groups

The Coalition helps set national anti-fraud policy through our hands-on advisory work with major national groups.

We’re the lead anti-fraud adviser to America’s state insurance regulators. The Coalition helps the NAIC’s anti-fraud task force shape influential model bills that states often adopt.

Thwarting crooked contractors and airbag scams were highlight issues.

The Coalition also regularly educated the NAIC’s Consumer Liaison Committee about scams and their impact on consumers.

The need for strong contractor and airbag laws was a key message the Coalition also pursued as the lead anti-fraud advisor to the National Conference of Insurance Legislators.

“We’re the lead anti-fraud adviser to America’s state insurance regulators.”

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Healthy healthcare partnerships

Joint efforts played out through the Coalition’s work with a unique partnership.

The Healthcare Fraud Prevention Partnership pulls together federal agencies (Medicare, Department of Justice) ... state fraud fighters ... private health plans ... and property-casualty insurers to pool data and share strategy.

Last year was a breakout year. The HFPP identified a record number of suspect medical provider and uncovering new scams. The partnership has saved more than $250 million in recoveries and fraudulent claims not paid since it was formed in 2012.

More than 60 organizations had signed on as partners by the end of 2015. To enhance data exchange, Computer Sciences Corporation was hired to pool and analyze billions of bits of data submitted by partners.

“The HFPP identified a record number

of suspect medical provider and uncovering

new scams.”

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Arsonist reveals secretsHome fires: Convicted cheater shows how to expose arsonists

“If our house be on fire, without inquiring whether it was fired from

within or without, we must try to extinguish it.”

—Thomas Jefferson

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Insurers should better probe home fire claims before so quickly paying claims that turn out to be arsons.

So said convicted insurance arsonist Kenny Allen and the investigator who helped bust him. Their riveting presentation was a highlight of the Coalition’s annual membership meeting in December.

Noted experts from around the U.S. revealed new trends in exclusive briefings that help inform the Coalition’s strategic goals.

Allen led a large arson ring that torched 62 homes and 11 vehicles, mainly in the Muncie, Ind. area.

His gang stole $3.4 million until he and 44 other ring members pleaded guilty in 2008. Allen served nearly four years in prison. Today he has an honest job delivering FedEx packages. Allen says he’s gone straight and is trying to show insurers how to better spot clues of arson schemes like his.

Allen teamed with former federal arson investigator Mike Vergon in the Coalition presentation. Vergon helped break open Allen’s crime ring. They’re now friends and colleagues. Vergon today runs his own arson investigation firm.

Allen routinely used bluster to intimidate insurer adjusters into paying fire claims. He often fried chicken wings on the stove, then left with the wings cooking.

Kenny Allen convicted insurance arsonist

“Noted experts from around the U.S. revealed new trends in exclusive

briefings that help inform the Coalition’s

strategic goals.”

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cheap junk furniture into homes, then made inflated claims for phantom higher-end possessions.

All insurer personnel involved with a fire claim should ask pointed questions, and the same questions, at each stage of the claim, Vergon advised.

This will elicit more information, and see if a claimant’s alibi and other parts of the story remain consistent throughout the claim process.

Agents, adjusters, claim and subrogration staff, SIUs and others all should ask detailed questions — while being respectful of a claimant’s possibly difficult personal losses. Claimant alibis were important clues that often weren’t probed.

Information gathers also should be carefully packaged and made available to other insurer staff involved with the claim. Information often varies in quantity and quality. Some also is lost or misplaced, leaving incomplete files.

“Who are you to say it wasn’t an accident. I was preparing to fry up some wings, got distracted and left the grease on the stove too long,” he forcefully questioned adjusters and investigators.

Threatening to complain to the adjuster’s boss also worked. “I want the name and phone number of your boss. I want to speak about the way I am being treated,” he routinely told insurer adjusters.

Larger insurers often were easy targets. Their adjusters had big caseloads and often were in a hurry to close claims.

Nor did insurers regularly communicate with each other to see if the same “homeowners” were making suspiciously large numbers of fire claims in the same region, Allen said.

Another tactic: Hire a compliant and crooked public adjuster to package claims.

Nor did agents visit homes to check contents before binding the policy. Allen and ring members often stuffed

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Insurance plotters wreck lives, invent easy excuses for thievery

Why we fight

Steven Krawitz Beto Mejia William Worthy

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The lawyer stole $1.9 million of settlements from 50 trusting clients. Most clients received no money, and some received a fraction. Krawitz received up to 12 years in federal prison.

Lousy role model. Robert “Beto” Mejia preached the value of hard work and discipline to the mostly lower-income football players at Mendota (Calif.) High School. A popular community role model, Mejia inspired the undersized school to over-sized championships and trophies.

Mejia also was an insurance thief. He told his insurer that someone stole his ATV from the bed of his pickup truck. It was parked in front of his home while he dined at a restaurant, he lied. Mejia sold out his values and players for a $4,000 insurance claim.

He took faked the theft because he didn’t want to pay for repairs. Mejia pleaded no contest and received two years of probation.

Just a tiny white lie. ... Nobody will miss the money. ... Everybody does it. ... Because I can. People find convenient excuses to steal insurance money. Thievery pays the mortgage, buys a new SUV or builds a vacation home. Theft is easier than succeeding honestly, crooks often reason.

Lost amid the slippery excuses are innocent victims. Insurance fraud hurts. Schemes carve a trail of riven lives, ruined health and broken dreams. Witness:

Ruin clients. Robert Rough had cancer. He’d already lost his business after a car crash cost him full use of his hands. Rough’s Manhattan personal-injury lawyer Steve Krawitz stole his $100,000 insurance settlement.

Krawitz also stole from a 96-year-old great-grandmother who broke her shoulder when a car hit her.

A student was hospitalized for three months and needed brain surgery after a crash. Krawitz looted the fellow’s insurance settlement.

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Fake health plans. Oklahoma real-estate agent Bob Harper was preparing for his heart pacemaker implant. He discovered his supposed health insurance was worthless — just days before the procedure.

William Worthy had sold him fake health insurance. The South Carolina man sold the junk to 17,000 Americans around the nation. He stole $28 million and lived a pasha’s life of luxury.

Some victims had acute medical problems, even cancer. Yet Worthy refused to pay their large medical bills. Victims were left to fend for their lives and health. They often were saddled with thousands of dollars in unpaid medical bills.

Another Oklahoma resident, Glenda Hey, had shortness of breath and chest pains. She needed $32,000 worth of hospital tests. Worthy refused to pay.

A Houston man had emergency back surgery, only to discover Worthy wouldn’t pay his $105,000 bill.

Worthy finally paid up: He’ll spend nearly seven years in federal prison.

“William Worthy had sold him fake health insurance.”

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Slip-and-fall ring slipped and fell under prosecutor’s skillful

How we fight

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Alert homeowners in a Philadelphia neighborhood spied a disturbing pattern. Pedestrians kept saying they slipped on small cracks in sidewalks in front of people’s homes.

The pedestrians were painfully injured, they said. They kept making large injury claims against the neighbors’ homeowner policies.

Something wasn’t right. The neighbors went to the District Attorney in Philadelphia. It was the right place to go. Linda Montag is with the DA’s insurance-fraud unit.

Montag confronted a major slip-and-fall ring. It was one of Philadelphia’s largest insurance rings in recent memory.

A local attorney named Andrew Gaber ran the fraud operation from his downtown office. He’d assembled a complex crime ring that bilked 21 insurance companies out of at least $400,000 in false injury claims.

Gaber hired an army of recruiters to bring him “victims” off the streets. Many were homeless and drug addicts looking for spare cash. They would be the fake slip-and-fall victims.

Gaber’s ring targeted neighborhood sidewalks that had only minor cracks that didn’t look too obvious.

The phony victims were coached how to fall and act injured.

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Gaber then filed bogus insurance claims for equally false injuries.

The scam lasted seven full years. The deception made Gaber a rich man at the expense of insurers and their policyholders.

Montag went after Gaber’s operation with relentless force. Her investigation took more than two years of teamwork. She worked hand in hand with detective Al Quintile and other skilled members of the DA’s fraud unit.

Top-to-bottom searches of bank records plus files of Gaber’s law firm provided important evidence.

Recordings of conversations by suspects and Gaber himself further exposed the large conspiracy. Insurance companies, NICB and others produced valuable evidence.

Montag assembled more than 350 exhibits for the grand jury. Dozens of witnesses also testified. Grants of immunity gave some suspects a big incentive to turn in fellow ring members.

Gaber was cornered. He saw no way out. Gaber shot himself instead of facing trial and certain conviction.

Virtually his entire ring pleaded guilty as well. That’s nearly 50 suspects. Like Gaber, they knew they had no chance.

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Government affairs• Seek stronger state anti-fraud laws;• Defeat weak legislation;• Expand joint grassroots lobbying;• Seek collaboration with outsidegroups; and• Expand website as nation’s hub of legislative information.

Public outreach• Make fraud a visual experience for consumers;• Reach consumers using mobile devices;• Grow social media as top-tier outreach tool; and• Expand Prosecutor of the Year and Hall of Shame efforts.

ResearchPublish reports covering: • Drivers lying about where they garage vehicles; • State insurance-fraud bureaus; • Life & disability schemes; • Insurance fraud globally; and • Criminal sentencing trends.

Flash Forward

“The future belongs to those who see

possibilities before they become

obvious.” —Entrepreneur

John Sculley

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Members

Consumer organizations

American Council on Consumer Interests*Call For ActionCenter for Business & Economic Research,

Marshall UniversityCenter for Consumer Affairs-University

of Wisconsin.- Milwaukee*Citizen Advocacy Center*Consumer Action*Consumer Alliance*Consumer Federation of America*Consumer Federation of the Southeast*Families USAFlorida Consumer Action Network*Foundation for Payments Fraud

Abatement & ActivismIndiana University of PennsylvaniaInternational Association of Lemon Law

Administrators*National Association of Consumer Agency

Administrators*National Center for Prevention of Home

Improvement FraudNational Consumers League*National Fraud Information Center*National Urban League*West Virginia Securities Commission

Government organizations

Bucks County District Attorney’s OfficeFlorida Department of Financial Services,

Division of Insurance FraudFlorida Workers’ Compensation Joint

Underwriting AssociationGeorgia Insurance Commissioner’s OfficeIllinois Department of InsuranceInternational Association of Insurance

Fraud Agencies *Iowa Insurance Fraud BureauKansas Insurance DepartmentLouisiana Auto Theft & Insurance Fraud

Prevention AuthorityLouisiana State Police*Maryland Automobile Insurance FundMaryland Insurance Administration -

Insurance Fraud DivisionMassachusetts Department of Industrial

AccidentsMinnesota Department of Commerce

Fraud Bureau National Association of Insurance

Commissioners*National Conference of Insurance

Legislators*National Criminal Justice Association*

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Insurance organizations

AIPSOAllstate Insurance Company*American Family Insurance *American Insurance Association*Amtrust North AmericaAssurantBlueCross BlueShield AssociationCitizens Property Insurance CorporationCNA*Country FinancialEMC Insurance CompaniesErie Insurance*Farm Bureau Insurance of TennesseeFarmers Insurance Group*GEICO*Grinnell Mutual ReinsuranceHanover Insurance Group*Harleysville InsuranceHastings Mutual InsuranceHomesite InsuranceIAT Group of CompaniesInsurance Company of the WestInternational Association of Special

Investigation UnitsJohn Hancock Financial Services*Kentucky Employers’ Mutual InsuranceLancer Insurance CompanyLiberty Mutual Group*Mass Mutual*MetLife*National Association of Public

Insurance Adjusters

National District Attorneys Association*NC Department of Insurance Criminal

Investigations DivisionNebraska Department of Insurance - Fraud

Prevention DivisionNew Jersey Department of Banking

& InsuranceNew Jersey Office of the Insurance Fraud

ProsecutorNew York City Police DepartmentOffice of Attorney General, ArizonaOffice of the Attorney General, ColoradoOffice of Attorney General, Pennsylvania*Office of the Cape May (NJ.) ProsecutorOffice of Medicaid Inspector General (NJ)Office of Medicaid Inspector General (NYS)Ohio Department of InsuranceOklahoma Insurance DepartmentOrange County District Attorney (Calif.)Pennsylvania Insurance Fraud

Prevention Authority*Pennsylvania State PoliceRhode Island Workers Compensation

Fraud UnitSan Diego County (Calif.) District

Attorney*San Francisco District AttorneyTexas Department of Insurance Fraud UnitUSDA Risk Management AgencyVirginia State PoliceWashington State Department

of InsuranceWest Virginia Office of the Insurance

Commissioner

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Coalition staffDennis JayHoward GoldblattJames QuiggleElijah MercerKendra Smith

National Health Care Anti-Fraud AssociationNational Insurance Crime Bureau*National Society of Professional

Insurance InvestigatorsNationwide Insurance Company*New Jersey Manufacturers Insurance

GroupNew York Automobile Insurance PlanOneBeacon Insurance*Pinnacol AssuranceProgressive Insurance*Property Casualty Insurers Association

of AmericaPrudential InsuranceScottsdale InsuranceSelective InsuranceSentry Insurance*State Farm Insurance Companies*Stillwater InsuranceSwiss ReThe Hartford*The Standard Insurance CompanyTravelers Insurance*Zurich North America*

Anti-fraud resource organizations

BAE SystemsCARCO GroupClaims Verification, Inc.CoventBridge GroupDelta Associated Investigations

G4S Compliance & Investigations Global Elite Risk Management, Inc.Hub EnterprisesIBM AnalyticsIdentity Theft Resource CenterIDologyInform Software, Inc.Insurance Committee for Arson ControlInternational Association of Arson

InvestigatorsISGISOLemieux & AssociatesLexisNexisMedical Identity Fraud AllianceNorth American Training Group PhotoFax, Inc.Polonious SIU SystemsPPPFD, Inc.SAS Institute, Inc.Sedgwick Factual PhotoThe Robison GroupThomson ReutersTIG Risk ServicesTransUnionVeracity ResearchVerisk HealthWatch House International, LLC* Member Board of Directors

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Washington, D.C. 202-393-7330

www.InsuranceFraud.org