Jim Schweitzer of The National Insurance Crime Bureau: “No matter the type of fraud, our goal is to get these cases prosecuted.”

Jim Schweitzer As chief operating officer and senior vice president, Jim Schweitzer’s day-to-day responsibilities involve field operations. Field operations consist of 180 investigators and 15 analysts that are headed by eight regional directors. Operating for more than 100 years, NICB has historically been focused on vehicle crime and fraud. In the last 25 years it has expanded to include medical-related fraud, now its top priority, and commercial fraud. NICB has 380 employees who work diligently with law enforcement on behalf of its members to support their efforts to fight insurance crime and fraud.

“Innovations in Insurance” is a Q&A Enservio blog that interviews thought leaders working to improve the quality of work while managing change within their organizations.

 

In NICB’s fight against crime, what does “innovation” mean to you?

When it comes to fighting fraud and insurance crime, you have to start with the innovative use of analytics to direct and guide your investigations. We at NICB have been applying analytics to these problems for years. As we move to the future, one of the areas we’re looking at for innovative development is the application of fraud analytics in ways that make us more efficient and allow us to have a greater impact.

We focus our investigations on multi-claim, multi-carrier type cases. We don’t replicate what Special Investigative Units, or “SIUs” can do for themselves. Rather, we’re a force multiplier for the SIUs. We build these criminal cases and present them to prosecutors in a way that they can best understand them. No matter the type of fraud, whether property crime, medical fraud, vehicle crime, or commercial fraud, our goal in the investigative areas of NICB is to get these cases prosecuted.

Using advanced analytics allow us to present some of the rather complex investigations in more simplistic terms, and in ways that a prosecutor feels comfortable in talking in front of a jury.

 

What types of technologies is NICB using?

The various analytical packages we use are fairly common. It’s how we apply the tools and apply the data, as well as the results the analytics provide us which really give us the edge. We’re able to take this data, analyze it, and get the result of that analysis into the hands of our members, utilizing our alerts. This empowers our members to ultimately use that information for their own internal processes.

As far as products that are exclusive to the NICB, I would point to our medical database, where we have aggregated billing information from over 30 of our members. We identify and analyze this data then produce what we call MedAWARESM alerts out to the membership, identifying medical providers who are billing in some way outside the norm.

 

What are you doing to root out fraud in property claims?

At times we put together “bait houses” that focus on hail fraud or on contractor fraud. In a bait house scenario we’ll work with law enforcement to set up undercover operations. We then make it apparent to any contractor that might be willing to “bend the rules” a bit to visit the house and offer his or her wares, so to speak. Using this technique, we’re able to put the word out to the particular contractor community which is prone to committing fraud that it might not be the wisest thing to do.

We work with many police departments around the country to put these bait packages together. Not only do we stage bait houses, but we also use bait cars and bait motorcycles. When there are frequent smash-and-grab type robberies taking place in a certain neighborhood, the police department may put a computer on the front seat of a car. When that bait package is stolen, it’s tracked, and the perpetrators are arrested.

 

How does Big Data play into the NICB?

Ultimately, it’s all about the ability to dig into the data to find what you’re looking for; to find those schemes and those organizations that are linked to criminals. And with such a proliferation of data, the team that can analyze that data and make something out of it will win. The answer’s in data. You just have to be able to dig in there and find it. And that’s what we pride ourselves on being able to do.

While insurance fraud is not at the top of the list when it comes to crimes that are investigated by law enforcement, insurance fraud does impact the public directly in their pocketbooks. Anything we can do to encourage law enforcement to investigate insurance fraud, we stand ready to help them do that.

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