© 2019 by New England Chapter International Association of Special Investigation Units

Course Descriptions - 2018 Joint Conference

We hope you enjoy the variety of courses that we are offering at this year's event.  Below, please find a more detailed description of the course and what the instructor intends to discuss.  Don't forget to check out our Speaker Bio page for more information on the instructors, as well as our schedule of events!

Litigation Loans

The session will introduce attendees to the emergence of “litigation loans” and their growing impact on third-party bodily injury insurance claims. As their name suggests, litigation loans are loans issued by third parties to bodily injury claimants or their attorneys, which are tied to the outcome of an individual personal injury insurance claim or lawsuit. 

In theory, the loans are designed to ease the financial burden of a claimant (or their counsel) until the subject claim is settled; however, in reality, these loans are often issued without regard to the ability of the recipient to make payments or the value of the underlying claim and have little to no stipulations on their usage. Further, the loans serve to prolong the claims settlement process, encourage pursuit of frivolous or fraudulent claims and contribute to starkly differing claim valuations by insurers and claimants, likely leading to an increase in claims which go to litigation, and costs for claims departments.  

Key learning objectives:

 

  1. Introduce attendees to the concept of litigation loans and their history.

  2. Advise attendees of the effects of litigation loans on claims handling and settlement.

  3. Inform attendees of what claims handlers can and cannot do to combat the influence of third-party lenders

Adam J. Brand, Brand & Tapply, LLC

NESPIN Pawn Shop Database (ATIX)

Det. Oliveira will demonstrate various ways to search the pawnshop data-base that will best assist investigators with their investigations/searches. Speaker will emphasize the importance of partnerships with local sworn police officers who have full access to all of NESPIN resources.

Key Learning Objectives:

  1. Attendees will hopefully walk away with a good sense of how to navigate the pawnshop database.

  2. Attendees will hopefully think “outside the box” when searching the database

  3. Attendees will understand the value in partnerships with local sworn law enforcement personnel and will have a great understanding of NESPIN resources that would be available through partnerships with sworn officers.

Det. Mario Oliveira, NESPIN

Preparing for Deposition and For Trial

Attorney Medoff will be presenting a seminar on Preparing for Deposition and For Trial.  The course will review the applicable rules of civil procedure regarding the manner in which depositions may be conducted and will discuss what a deposition is, how they are conducted, and how best to prepare for, and testify at depositions.  The attendees will be provided with Deposition Guidelines discussing what to expect and how to best prepare for testifying at a deposition. 

 

Key Learning Objectives:

  1. a basic understanding of the deposition process;

  2. what to expect when testifying at a deposition; and

  3. how best to prepare for depositions and to present in an effective and professional manner. 

Bruce Medoff, Smith & Brink, P.C.

The Anatomy of a Civil Action From Inception Through Jury Trial

What is a civil action?  How does it proceed from inception through trial?  The Complaint has been drafted, you’ve named the defendant(s), you’ve filed the Complaint with the Court, the defendant(s) have been served by the sheriff, what now?  Answering the Complaint, affirmative defenses, discovery in the form of interrogatories, requests for production of documents, requests for admissions, depositions, dispositive motion(s), mediation (required or voluntary) motions in limine, expert witness and evidentiary hearings, the trial finally begins.  Jury empanelment, voir dire, challenges for cause, peremptory challenges, swearing in the jurors, judge instructs the jurors, opening statements, call the first witness.  Direct and cross examination, stipulations, closing arguments, judge instructs jurors on the law, jurors sent to deliberate, and the hardest part, waiting for deliberations to conclude and presentment of a verdict.  Come to participate, discuss, and provide insight regarding what happens in your state from initiation of a complaint through jury trial.

Key Learning Objectives:

1.        Learning the step by step process of a civil action;

2.       The parts of a civil action and how they are developed; and

3.       How things vary from court to court and state to state in New England.

Jack Parenteau, Parenteau & O’Hara, P.C.

The Eye in IoT: Using Connected Device Data in SIU Investigations

Accompanying the proliferation of connected or Internet of Things (IoT) devices is a zettabyte-sized source of data that is potentially useful in fraud investigations.  Attend this session to learn what kind of devices exist, how they generate machine-witnessed data, and how that data may be acquired and utilized in investigating insurance losses and claims suspected to be fraudulent.  Usage rights and privacy issues associated with IoT data will also be discussed.

 

Key Learning Objectives: 

  •   what kind of IoT devices exist;

  •   how they generate data;

  •   where that data is stored;

  •   what privacy issues are associated with IoT data;

  •   how insurers can get access to IoT data; and

  •   how IoT data is useful in investigating fraudulent injury and property claims.

Roy A. Mura, Esq., Mura & Storm, PLLC

Goals and Ground Rules When Coordinating Public and Private Investigations of Fire Claims

The course will consist of a PowerPoint presentation and will outline best practices for insurers coordinating the private investigation of fire claims with parallel investigations being conducted by law enforcement personnel.  Selected Massachusetts statutes regarding immunity, the transmittal of information, and privacy, will be discussed as will pertinent Massachusetts cases addressing investigations conducted by law enforcement personnel in which insurance investigators have participated.  Issues regarding potential exposure to bad faith claims when instigating and/or participating in the prosecution and investigation of fire claims will be discussed and attendees will be instructed on how best to avoid exposure to bad faith claims when participating in the investigation of fire claims with law enforcement personnel. 

 

Key Learning Objectives:

  1. a basic understanding of the goals and ground rules of fire investigations from the prospective of law enforcement and insurers;

  2. understanding of statutes governing insurers participating in the investigation of fire claims; and

  3. methods by which insurance investigators may avoid claims of bad faith when investigating fire claims in conjunction with, or parallel to the investigation of such claims by law enforcement personnel. 

Capt. Paul Zipper (MSP), Bruce Medoff & William Tait (Smith & Brink, P.C.)

Dimished Value

Increasingly, automobile liability carriers are being presented with third-party property damage claims in which claimants seek to recover amounts above and beyond the cost of their vehicle’s repairs following an accident, namely for the vehicle’s “inherently diminished value”.  This form of damage is an intangible, subjective figure based on the simple notion that the mere occurrence of a collision automatically means the vehicle has a lower value than an identical vehicle without a collision history.  This difference in hypothetical valuations is the amount these claimants seek to recover, often facilitated by third-party companies who purchase these claim rights in exchange for a cut of any settlement obtained.  Often, these companies have little factual evidence to substantiate the purported loss in value.  This presentation will provide the carrier with relevant legal context and background, as well as practical methods for analyzing and contesting such claims prior to and during litigation.

Key learning objectives:

 

  1. Identifying suspect diminished value claims.

  2. Collecting the data to defeat diminished value claims.

  3. Fighting back on questionable claims. 

Timothy W. Tapply, Brand & Tapply, LLC

Evaluating Manipulation Under Anesthesia

Manipulation under anesthesia (MUA) will be explained by taking the audience from the accident scene through office treatment, diagnostic testing, and the MUA procedure while pointing out red-flags to trigger utilization and fraud reviews and illuminating key elements to help direct claims analysis, surveillance, undercover operations, and formulation of recorded statement, examination under oath, and trial questions.

Key Learning Objectives:

  1. Understand the MUA procedure to help navigate between utilization review and fraud unit jurisdictions

  2. Be able to identify red-flag indicators that establish a need for abuse evaluations and fraud investigations

  3. Understand MUA practices to be able to better evaluate provider and claimant truthfulness

Dr. John Cerf

Manipulations & Misrepresentations: The Practice of Delegating to Unlicensed Staff

This presentation examines national coding requirements, state chiropractic regulations, and recent decisions pertaining to one of the most volatile services being billed by chiropractors, the delegation of therapeutic exercise to unlicensed staff. A basic knowledge of relevant billing codes and chiropractic regulations will provide a greater understanding of the information contained in medical records and bills submitted for payment, which is necessary to detect these false charges.

 

Practitioners presumably prescribe therapeutic exercise with the goal to return each patient to his or her pre-injury condition. This service is commonly billed under Current Procedural Terminology (CPT) code 97110. The American Medical Association (AMA), which authored the CPT codes, designates CPT code 97110 as a therapeutic procedure, which must be rendered by a physician or qualified health care professional. The AMA defines a qualified health care professional as “an individual who is qualified by education, training, licensure/regulation (when applicable) who performs a professional service within his/her scope of practice and independently reports that professional service.” When a medical provider bills under CPT code 97110, they are representing that a physician or qualified health care professional rendered direct, one-on-one therapeutic exercise to that respective patient. If the service (i.e., therapeutic exercise) was not rendered by a physician or qualified health care professional, but instead, by an unlicensed and unqualified staff member (i.e., clinical staff), then billing under CPT code 97110 is a material misrepresentation of the service rendered. The foregoing charges are false and non-compensable.

Key Learning Objectives:

  1. Identifying improper medical coding practices committed by chiropractors in order to bill for services not rendered and/or not rendered as represented;

  2. Taking Examinations Under Oath with a mind toward investigating provider fraud; and,

  3. Applying relevant policy guidelines and decisions issued by the Massachusetts Board of Registration of Chiropractors in individual claim and major case investigations.

Doug McInnis & Marykate Williams, Morrison Mahoney

Role of the Attorney General With Respect to Insurance & Unemployment Fraud

The presentation will include a description of the mission of the Attorney General’s White Collar and Public Integrity Division, with a focus on Insurance and Unemployment Fraud.

Key Learning Objectives:

1.       How the Insurance and Unemployment Fraud Unit receives cases, agency partnerships, and key factors in evaluating a case for criminal investigation;

2.       A description of the various types of insurance fraud cases the Unit handles and the path of a typical investigation;

3.       Common evidentiary issues we face in insurance referrals, specifically premium evasion and workers compensation.

Jennifer Cotter, AGO

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Overview of Massachusetts Case Law, Statutes & Regulations Applicable To Automobile Property Damage Claims: When Does Questionable Conduct Create Civil Liability?

This presentation will focus upon how a small group of underutilized Massachusetts cases, statutes, and regulations function to govern the activities of insureds, claimants, auto repair shops, and towing facilities.  Special emphasis will be placed upon laws that impose civil liability for specific claims related activities.    For example, can a claimant engage in activity that makes them “automatically“ liable for triple damages and attorney’s fees under 93A?  Similarly,  can an insurance company deny an “entire” claim after it proves that “a portion” of the claim is false?

 

Key Learning Objectives:

  1. A better understanding of various Massachusetts laws that regulate the activities of tow facilities, repair shops and insureds who present automobile losses;

  2. Exposure to statutes and regulations that are rarely used by insurers in their ongoing efforts to combat insurance fraud; and

  3. Strategies and tactics that can be used to defend against unconscionable and deceptive business practices utilized by insureds, claimants and vendors

David Brink, Smith & Brink, P.C.

Cloning and Beyond

A review of the vehicle cloning problem, its evolution, and new trends

Key Learning Objectives:

  1. A clear understanding of how cloning differs from other vehicle crimes

  2. Resources available to claim investigators to identify possible cloning issues

  3. The impact of cloning on the insurance industry

Heidi Jordan, NICB

Behind The Curtain - Insurance Fraud Bureau of Massachusetts

This is your opportunity to ask questions of the IFB that you wanted to ask but never had the chance. This interactive session will provide an explanation on the how to submit a referral to the IFB and having it successfully prosecuted. There will be a discussion of the investigative process covering investigative tools and methods that are used.  Included will be highlights of the latest trends and changes to the IFB method of operation.

Key Learning Objectives

  1.  Understanding IFB referral and the evaluation process

  2. Learning which cases are successfully prosecuted

  3. IFB investigative procedures and processes

Anthony M. DiPaolo, Chief of Investigations

Federal Bureau of Investigation - Health Care Fraud Program Overview

The presentation will include a description of the mission of the FBI with respect to health care fraud; health care fraud schemes the FBI investigates; and case summaries.

Rita Iacone & Pepper Kravetz, FBI

Current Automotive Ignition System Updates, Mechanical and Electronic Diagnostics

The class will provide the fundamentals of mechanical ignition locking systems, how transponder-based ignitions keys operate, and the technology of Passive Keyless Entry and Start (PKES) systems (push-to-start). The class will explore the mechanical and electronic diagnostics available for these systems and address the potential for Radio Frequency Relay Hacking.

Dennis Lyons, S.D. Lyons

Conducting Clinic Visits

Research the rules and regulations for the state that you are conducting the visit in. Discuss the focus of the visit.  Using the gathered intelligence.

Key Learning Objectives:

  1. How and where to obtain rules and regulations.

  2. That you are doing the visit for the proper reason.

  3. What to do with the information that you have gathered.

  4. NICB is a resource; research and support.

Mark Huard, NICB

Identity Fraud

This program will discuss various methods to mask an identity, create a new identity or utilize another person’s identity to commit insurance related fraud.  I will also speak about the rise in juvenile identity theft.  The presentation will concentrate on the theft of identities by employees with access to personally identifiable information.

Key Learning Objectives: 

  1.        The importance of establishing identity

  2.        Protecting your workplace from insider threats

  3.        What to do when you realize you have been victimized by an identity thief.

Adam D. Schneider, SSA/OIG

Arson Fraud Investigations and Financial Interest in Arson For Profit

How you can enhance arson for profit investigations with financial investigative techniques. Case studies from actual arson investigations.

Key Learning Objectives:

  1. Introduction to the Bureau of Alcohol, Tobacco, Firearms, and Explosives (ATF) and the ATF Financial Investigative Services Division (FISD)

  2. Financial aspects of arson investigations
  3. Financial evidence for successful arson prosecutions

Thomas J. Chapasko, ATF

Independent Medical Record Reviews

Independent Medical Record Reviews (IMR) should tell the story of the patient’s care from the time of their accident through their discharge from care.  The most effective IMR’s will chronologically identify providers, summarize treatment rendered, and provide opinions based upon the documentation reviewed. Documentation may include medical documentation, patient interviews/EUO’s, damage estimates, accident reconstruction reports, etc.  The intent of this lecture is to provide insight into the thought process of a physical therapy reviewer as they go through the documentation provided, discuss the importance specific documents, and identify discrepancies in the documentation that will have an impact on the opinions expressed in the final report.

Key Learning Objectives:

  1.  The most important documents needed for a comprehensive IMR

  2.  The thought process utilized by the reviewer when performing an IMR

  3.  Discrepancies noted in medical records and their significance to a reviewer

Bruce Levine, PT, MS

The IASIU Code of Ethics: Our Living and Breathing Code

This course will begin with a discussion as to how IASIU’s Code of Ethics is utilized on a daily basis before addressing the methods to ensure our investigations are consistent with and abiding by state and federal law. This course is designed to highlight and analyze those tougher and not-so-clear ethical dilemmas that we face in fraud investigations, the proper and/or required responses to them, and the common rationalization of questionable/unethical conduct. We will discuss several case examples and how these ethical dilemmas affect each level of investigation, including claims personnel and management, special investigation units and vendors—namely cause and origin investigators, engineers, lawyers, and liaisons to law enforcement and government agencies. Lastly, this course will outline ways to avoid the many pitfalls that could be used to form the basis for bad faith and violations of state consumer protection laws that we often see in litigation. 

Key Learning Objectives:

  1. Identification and clarification of ethical dilemmas faced in fraud investigations on all levels.

  2. Proper/required responses to these ethical dilemmas.

  3. An understanding of how we can uphold our high ethical standards to construct airtight fraud investigations and defenses against bad faith litigation

Steven Ryan, Halloran & Sage

Inappropriate Use of the 25 Modifier Among Osteopaths

A discussion and case presentation of inappropriate usage of the 25 modifier amongst Osteopaths when billing for Osteopathic Manipulative Treatment procedures in conjunction with Evaluation and Management codes.

 

Key Learning Objectives:

  1. Attendees will have an idea of what to be on the lookout for (“red flags”),

  2. Will know what federal regulation allows, and

  3. Will know what is needed to successfully prosecute one of these cases.

Catherine Richard, DHHS/OIG

ISO ClaimSearch® Updates

Were you aware that the text version of the ISO ClaimSearch® match report is due to be sunset effective July 1, 2018? Join us to walk through the visualized Match Report that will replace the text version and is available today by logging into the web portal at www.claimsearch.iso.com.  This is an opportunity to walk through the visualized platform which will be the vehicle for all future system enhancements. We’ll explore the ClaimSearch Alerts Dashboard rolled out last year that is accessible to all SIU Users.  Finally we’ll discuss how these changes may impact your internal workflow and relationship with front-line claims staff.

Key Learning Objectives:

  1. There is more to ISO ClaimSearch® than Claims Inquiry!

  2. ISO ClaimSearch® Users with an SIU Profile are able to access the ClaimSearch Alerts Dashboard and unmask data.

  3. Current and pending updates to ISO ClaimSearch® are likely to impact your company’s internal workflow.

Karen A. Ward, Training Manager, ISO ClaimSearch®

Social Media Updates

Join me as we discuss the latest social media trends, platforms, limitations, and uses that investigators need to know.  Learn about what has changed with Facebook as a result of the Cambridge Analytica scandal, how you can find data with these limitations, and how Facebook Marketplace might be your new friend.  Learn about Instagram explore options and how to use this as a geofence of sorts to find relevant posts.  Discover Snapchat maps on your PC, how to leverage YouTube properly to find information, why lesser known sites like VKontakte (Russian for InContact), QZone, WeChat, Viber, Tango, and KIK might be as important to use as Instagram.  Finally, we will discuss the Dark Web and why this difficult to access location of the Internet might be an important place to search for information.

Joe Stephenson, Hagerty

Airbag Control Modules

This presentation will discuss airbag control modules in vehicles.  It will cover how it started, what to expect, restrictions, and some real life cases that Mr. Cretella has been involved in.

Tony Cretella, Unified Investigations & Sciences, Inc.

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