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Medical Insurance Fraud Investigation

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Case study # 2. Medical insurance fraud Investigation

The key point is universal -  to defraud the insurance company and hide back home.

Medical Insurance fraud investigation in Latvia | Lithuania | Estonia | Hungary | Greece |Worldwide

“From our experience in international Insurance Fraud investigations, the key point is universal –  to defraud the insurance company and settle back home for a while” – Baltic Security.

Baltic Security investigates full scope of insurance fraud in Latvia | Lithuania | Estonia. Medical fraud | Vehicle Accident fraud | Workplace injury fraud | Car theft fraud | Arson fraud are among the most popular insurance fraud investigations we have encountered.

“Not every accident is a fraud, but every insurance fraud is an accident”  – Baltic Security. 

Example of Medical Insurance Fraud Investigation in Latvia: Client – Investigative Company from the UK asked Baltic Security for assistance in unclear insurance investigation in Latvia and Lithuania. The objective was to trace the location and provide surveillance of the individual that was suspected to perpetrate a multimillion $ medical insurance fraud in the UK.  Our detectives conducted a background check with source inquiries. Shortly, the individual was allocated and assistance our fraud investigative team with physical surveillance was ordered.

Soon after Baltic Security surveillance unit arrived, a male with similar but not easily recognizable appearance was detected exiting the apartment building. Male was happily walking around and playing with the pet. Notwithstanding the insurance claim of total immobility, the subject’s behavior was different from the anticipation.  Further pieces of evidence of normal physical activity were detected and submitted to the client for further realization.

This case shortly describes a common usage of private investigators in Latvia | Lithuania | Estonia | UK | USA and around the world. Often, the cases are more complex and require in-depth information gathering with the visits to multiple locations. In such complex cases, it is important to follow the correct algorithm in order not to jeopardize the whole operation.

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ACFE European Fraud Conference 2012 Summary

European Fraud conference with the representatives from 34 countries including Latvia, Belgium, Holland, Nigeria, India, Poland, Latvia, USA, UK, Ukraine, Russia etc. were sharing experience on fraud prevention, detection, and investigations worldwide.

Some Highlights of Vladislav Chernousov presentation:

Detection and investigation of Corporate Fraud in Eastern Europe has to be taken considering the cultural specifications and local legislation. Each instance of potential signs of fraud has to be investigated separately and no universal approach on fraud elimination shall be applied.

Brief history of the development of Eastern European and Baltic countries within the last 20 years. Some most common examples of corporate fraud and due diligence investigations in Latvia | Lithuania | Estonia  daughter companies or branches of the foreign companies. The dilemma: whether  to conduct complex fraud investigation which may lead to unnecessary public attention.

Ostrich approach – often executives and directors completely unaware of the fraud that is taking place at their companies. When first signs of fraud are detected it is crucial to apply appropriate measures to reduce or eliminate fraudulent activity and investigate if necessary. The effective investigation shall be conducted by the professionals.

Wanna Be Wife scam has been actively developing since EU expansion since year 2004. Well organized groups often closely connected to money launderers and criminals, supply models to clubs. Ladies pretend to fall in love with the wealthy individuals. First meeting with the client typical happened at the night clubs or Bars. Typically, models were acting naturally as B-girls. The final objective of the scam closely supervised by the superiors, to get as much money as possible from wealthy foreigners. When the client starts to get stubborn or has no more money to pay, the supervisors apply delicate removal of the wanna be wive from the project, by a third person that may play role either as a boyfriend, brother or another relative. 

European Fraud Do and don’ts of the fraud prevention policies in the effective corporate environment.  Case study of the actual fraud investigation that was taking place at the industrial facility in Estonia.

Abstract

Along the technical progress and economic development, the scale of fraudulent activity in the corporate environment is increasing. In order to effectively minimize losses and harm from such activity and prevention techniques shall be utilized and carefully applied where necessary. Highlights of fraud investigations in Latvia | Lithuania |Estonia  i.e. Baltic region as a vital intersection point between East and West are used.

Fraud prevention policies that are used by the large companies often touch very sensitive issues such as employee trust. From one side it is important that employees feel that their employer rely on them and their actions. Complaints due to the personal dislikes and other undeveloped actions may destroy the environment of trust. However, from another perspective, everyone including employees and board members must understand that fraud is being considered seriously and violators will be punished.
Detecting and investigating signs of fraudulent activity shall never be overestimated or taken too superficially. For instance, one has always remember about the impact on the corporate reputation and internal environment of putting the wrong person under investigation.

Abstract of the presentation that Mr. Vladislav Chernousov, CEO of Baltic Security was selected to present at 2012 ACFE European Fraud Conference.

Tags:  fraud investigations | due diligence | B-girls

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