Claims Fraud Workshop
ALARM Scotland Stirling University Management Centre 8 September 2008
Claims Fraud Workshop - Content
CLUK Investigation Services Fraud Definitions & Categories
CLUK Anti Fraud Strategy
Investigation Tools & Techniques
Claims Fraud Indicators
UK Locations of Investigation Services
125 Staff throughout UK 3 Service Centres 54 Special Investigators 28 Assistant SI 20 ITI Operators Specialists Support
Glasgow
Belfast
Newcastle
Leeds
Manchester
Leicester Birmingham St Albans Ipswich
Cardiff
Redhill Fareham
Investigation Services
Household Claims Handling Commercial
Special Investigations
Motor
ITI
Fraud Management Strategy
Liability
Screening Surveillance FraudLine
Claims Fraud – ABI Definitions
Proven Insurance Fraud
Claims Fraud – ABI Definitions
Suspected Insurance Fraud
Claims Fraud - Categories
Fictitious Losses Staged Events
Material Misrepresentation or Exaggeration
Multiple Claims
Claims Fraud – the Cost.
Victimless Crime? Claims Fraud estimated to cost each household in UK £655 a year (ABI 2006). Estimate of annual cost of £2 Billion (ABI 2006).
Cunningham Lindsey Anti – Fraud Strategy:
Prevention ( Public Awareness ). Detection (Internal fraud screening).
Containment (Investigation).
Measurement (Savings to Organisation).
Prevention
Public Awareness Deterrents
Fraud Line
Detection:
The Identification of fraudulent claims:
Bespoke screening process for each type. Internal data mining.
Detection - the tactics:
Process Training Measurement Audit Accountability Culture
Containment:
The management of those fraudulent claims to ensure that no payment is made now or in the future.
Containment – the Investigation
Investigative Interview (recorded telephone call) Field Investigations and Enquiries Desk Based Enquiries Tools and Techniques Any combination of the above
Measurement:
To evidence value and demonstrate consistency with FSA expectations to Reduce Financial Crime.
Key Investigation Indicators
Where is the fraud? What should you be especially aware of?