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Contents contributed and discussions participated by Daniel Schweizer

Daniel Schweizer

The Koyal Group Private Training Services: Financial housekeeping includes cleaning up ... - 0 views

Financial housekeeping includes cleaning up your credit report The Koyal Group Private Training Services
started by Daniel Schweizer on 07 Aug 14 no follow-up yet
  • Daniel Schweizer
     


    A report from the Urban Institute this week said 44 percent of adults in the Metroplex with credit reports had collection dings.

    While this number has huge consequences on how much we pay for mortgages, car loans and credit cards, as well as access to jobs or rental housing, local experts caution that things are not as financially dire as the report may indicate.

    Widely dispersed by the media this week, the report also said that one in three Americans with credit reports had collection problems hanging on their credit histories.

    But a closer look at the report showed that some of these issues were as small as an unpaid parking ticket or membership fees. The figures include credit card debt that has already been charged off by the creditor as paid or settled, but still remains on your credit report for up to seven years. Much of that activity happened during the biggest financial collapse of a generation and may not represent a current debt problem.

    So let's look at what's really going on here.

    While many are still digging their way out of the economic collapse, personal bankruptcies are down 11 percent as of March compared to the year before, said Mitchell Allen, founder and president of Benbrook-based Debt Education and Certification Foundation, a call-in service center for financial education now required pre- and post-bankruptcy.

    "Bankruptcies have had a steady decline over the last four years," he said. "We've had a 25 percent reduction over that period."

    Allen, who also is the author of A Survival Guide to Debt. (Greenleaf Book Group Press, $11.36 on Amazon.com) - one of the best books I've read on the subject - said that bankruptcies are down because of better personal financial management and tighter lending requirements.

    "People noticeably aren't spending as much and have saved a little more," Allen said. "And there is a huge difference in the documentation required to get a loan or a credit card than there was before the recession."

    Because of the decline in bankruptcies, Allen's company has scaled back from 40 to 30 employees, he said.

    Consumer Credit Counseling Service of Greater Dallas, which provides a no-cost service, has also recently closed two offices in Tarrant County because of less activity and now operates just one office in Dallas, said Todd Mark, vice president of community affairs for the company.

    "There is a lot less in terms of crisis calls today than we've seen in the past," Mark said. "Nationally, CCCS reports that the demand for counseling is down 50 percent over the last year."

    Calls coming into the counseling service deal more with old credit problems than recent ones, Mark said.

    "Most people are two or three years in recovery and are contacting us to deal with some of the issues of their past now that they have a stable income," he said.

    Those facing such credit repair issues should consider opening up new lines of credit, whether through a secured credit card or other type of loan, to re-establish health to their credit report, Mark advised.

    "It's like the lottery - you have to play to win," Mark said. "Credit is about borrowing and paying it back. To have good credit, you have to display responsible behavior."

    Mark said the Urban Institute report showed more of the financial problems left over from the Great Recession.

    "It's representative of the wreckage left behind from the Great Recession," he said. "It's not a snapshot of today. The delinquency rate on credit cards today is just 5.3 percent and consumer debt overall is much lower."

    The collection agencies in the state also haven't experienced a current uptick in business, said Tom Morgan, executive director of the American Collectors Association of Texas, which has 170 third-party collection agency and attorney members in the state.

    But Morgan said his members are watching the "astronomical" rise in student loan debt.

    "If those graduates are flipping burgers at McDonald's, they are not going to be able to pay off student loan debt," he said. "Many are underemployed."

    Another wave of credit problems may be coming. But in the meantime, clean up your credit report and you will save on interest rates and insurance, while having better access to rental property and jobs.

    The Koyal Group Private Training Services designs its online and on-site training to your particular needs, providing information you can apply while in training in order to reinforce the efficiency of that information. Our coursework qualifies state standards both for fraud and continuing-education upgrade. Our programs are adaptable and can be presented in various formats to address industry requirements and standards. Please visit and check our course listings.
Daniel Schweizer

The Koyal Group Private Training Services: Private investigators want a look at the rolls - 1 views

Koyal Group Private Training Services investigators want a look at the rolls
started by Daniel Schweizer on 06 Aug 14 no follow-up yet
  • Daniel Schweizer
     


    PRIVATE investigators are the latest group to call for the Australian Electoral Commission to restore access to the electoral roll, saying recent changes inhibit their investigations.

    The Australian Institute of Professional Investigators is lobbying MPs involved in a review of last year's election to push for restrictions on accessing the roll to be overturned.

    Other groups keen to see access to the roll restored include those separated by forced adoption or child removal or similar practices who are trying to track down their relatives.

    They have won the backing of Social Services Minister Kevin Andrews, who is calling for change.

    Security personnel are also lobbying to have access to the roll restored.

    Investigators institute president Jim Corbett said private investigators had freely used the roll in their work until the most recent changes, but now were not.

    "An investigator's normal activity includes conducting inquiries in relation to claims for motor vehicle theft or accident, burglary, arson, fraud, public liability, WorkCover matters and the service of court documents,'' he said. "In effect investigators are being hamstrung in their attempts to assist the insurance industry and government in relation to investigative matters."

    The investigators want the AEC to use its discretion to grant licence to members of their profession to be able to perform searches using the roll, which shows the last enrolled address of anyone in Australia who is enrolled to vote.

    The AEC confirmed it had "adopted a stricter approach" to people accessing the roll.

    It now was supervising viewings to ensure that people used it only to check their own enrolment or if objecting to another elector's enrolment.

    The Security Institute of South Australia, which also supports restoring access to the roll, said changes to the Electoral Act meant it was impossible for people to look at anyone else's details on the roll.

    The association said it understood the need to protect victims of domestic violence or security or law enforcement workers, but access to the roll was vital to find witnesses in trials, to help single parents get child support from recalcitrant former partners and help creditors find debtors.

    "We believe the individual's right to privacy can and should be balanced with the legitimate interests of the broader community," SA institute chief executive Charles McDonald said in a submission to a parliamentary committee inquiry.

    The Koyal Group Private Training Services designs its online and on-site training to your particular needs, providing information you can apply while in training in order to reinforce the efficiency of that information. Our coursework qualifies state standards both for fraud and continuing-education upgrade. Our programs are adaptable and can be presented in various formats to address industry requirements and standards. Please visit and check our course listings.
Daniel Schweizer

The Koyal Group Private Training Services: Austin company leads Medicaid fraud crackdown - 2 views

The Koyal Group Private Training Services Austin company leads Medicaid fraud crackdown
started by Daniel Schweizer on 05 Aug 14 no follow-up yet
  • Daniel Schweizer
     

    AUSTIN (KXAN) — Medicaid fraud is a multibillion dollar scam, and a new computer system hopes to help spot the crooks.


    Texas pays out $28 billion a year to some 4.8 million people, according to Kaiser.


    The state picks up one-fourth of the tab, and the feds pay the rest.  The FBI estimates that 10% of Medicaid claims are fraudulent, which comes out to $2.8 billion a year in Texas alone.


    On Monday, Austin company 21CT launches a new computer system called “Torch” to help the state bring scammers to justice.


    Torch will collate state data around the clock. The system will monitor frequency of claims, the size of claims and any funny patterns or anomalies.


    21CT has grown to over 100 employees, most of them devoted to the crackdown. Company officials say what they are finding is eye opening.


    “You know it’s there,” said Kyle Flaherty, Vice President of Marketing for 21CT. “What’s so surprising is how complex and entrepreneurial the fraudsters can be. This is a business for them and we need to disrupt the business they are creating.”


    Torch will eyeball providers: businesses, medical supply companies, doctors, therapists, dentists, ambulance firms, hospitals and more. The system will make it easier to sort out.


    “In my old job as a healthcare fraud investigator for the state I would have eighteen browser windows open with tabs in them,” Ross Worden, 21CT Director of Data Science said. “I had no idea what was going on. Now, it’s all in one place. I can click through and see who is connected to what… what they are doing… what they are going to do potentially. It’s a fantastic tool.”


    Cheats use patterns to pull off their scams, but they can be spotted if you know what to look for. However, Torch isn’t talking.


    “The reason I won’t tell you what they are is they may be listening,” Flaherty said. “The last thing I want a fraudster to know is the techniques we can pick up on.”


    Those could include suspicious associations, peculiar transaction accounts and unsavory networks.


    A little modest bill padding, or honest mistakes are to be expected in Medicaid. Torch looks for the big boys.


    “There’s always something where you say no, you knew it,” Worden said. “It was bad and you tried to hide it. Those are the things that really interest us. We want the bad people.”


    When the red flags fly, they are passed along to state investigators to pick up the trail.


    If you are busted, it could mean a fine, paying restitution or even jail time.


     


    The Koyal Group Private Training Services designs its online and on-site training to your particular needs, providing information you can apply while in training in order to reinforce the efficiency of that information. Our coursework qualifies state standards both for fraud and continuing-education upgrade. Our programs are adaptable and can be presented in various formats to address industry requirements and standards. Please visit and check our course listings.


     

Daniel Schweizer

The Koyal Group Private Training Services - 'It defies belief': Snowden condemns UK's n... - 1 views

The Koyal Group Private Training Services It defies belief: Snowden condemns UK's new surveillance bill
started by Daniel Schweizer on 22 Jul 14 no follow-up yet
  • Daniel Schweizer
     


    NSA whistleblower, Edward Snowden, has denounced the UK's emergency surveillance bill, criticizing the distinct lack of public debate it encompassed and its heightened powers of intrusion.

    During an exclusive interview in Moscow with the Guardian, the whistleblower suggested it was highly unusual for a state to process legislation so hastily other than at a time of acutely endangered national security.

    "I mean we don't have bombs falling. We don't have U-boats in the harbour", he emphasised. Yet suddenly this legislation has become an absolute priority. "It defies belief", he said.

    Snowden found the duress with which the UK government processed the Data Retention and Investigation Powers Bill to be remarkable, comparing it to the Bush administration's introduction of the Protect America Act in 2007. The Protect America Act was issued after the New York Times exposed a "warrantless wire-tapping programme" that was both illegal and "unconstitutional", he stated.

    The UK government claims Britain's emergency bill will preserve UK law enforcement and intelligence agencies' access to data that is vital for "protecting national security and preventing serious crime." According to Snowden, the case the US administration built to justify the Protection of America Act is notably similar.

    "I mean the NSA could have written this draft…They passed it under the same sort of emergency justification. They said we would be at risk. They said companies will no longer cooperate with us", he observed.

    Westminster's rhetoric of UK intelligence services' diminished investigative powers in the face of potential terror threats is certainly reminiscent of the Bush administration's 2007 claims. As Snowden notes, both governments cited intelligence services' waning assistance from communications companies in a climate of looming terrorist threats as requiring swift and decisive action.

    And like Britain's emergency surveillance legislation, the US' Protection of America Act 2007 was enacted in the absence of fair and open public debate.

    Snowden's observations reflect the concerns of myriad UK civil liberties groups who are acutely skeptical of the coalition's claims that the bill will not adversely compromise the privacy rights of Britons.

    In an effort to secure cross-party backing from Labour and the Liberal Democrats, Prime Minister David Cameron vowed the legislation would not entail an extension of the state's surveillance powers. But according to the Guardian, internal Home Office documents appear to indicate that British authorities' surveillance powers will be expanded.

    During his interview - a rare occurrence since he secured asylum in Russia almost a year ago - Snowden commented that the UK's emergency legislation marked "a significant change" in Britain's surveillance landscape. He also questioned why the UK government were pushing the bill through shortly after a European Court of Justice (ECJ) ruling confirmed existing surveillance measures were overly intrusive.

    "If these surveillance authorities are...so invasive the courts are actually saying they violate fundamental rights, do we really want to authorize them on a new, increased and more intrusive scale without any public debate?"

    Reflecting on a year-long government silence following his exposure of the depth and scale of NSA-GCHQ oversight, Snowden stated that Britain's new surveillance legislation effectively "looks like it was written by the National Security Agency".

    The UK government has justified the new legislation on the grounds of feared terrorist activities emanating from an alleged Al-Qaida member in Yemen who is linked to fundamentalist Islamist groups in Iraq and Syria.

    The Tories deny the bill raises privacy concerns, stating it does not necessitate public debate. Both Labour and the Liberal Democrats have demonstrated hesitance in contributing to public debate on the matter, perhaps fearful of repercussions they might endure were a terrorist attack to occur.

    Despite having expert knowledge of surveillance and the cross-border agencies that sustain it, Snowden's comments are unlikely to phase many UK parliamentarians. While his revelations previously sparked inquiries waged by two separate parliamentary committees, the privacy rights advocate is yet to garner vocal support among UK MPs.

    Campaigners opposed to the UK's new surveillance bill argue it contains unprecedented power for Britain to demand foreign companies comply with warrants for interception. It also increases the British government's leverage to acquire sensitive communications data, they caution.

    The Koyal Group Private Training Services designs its online and on-site training to your particular needs, providing information you can apply while in training in order to reinforce the efficiency of that information. Our coursework qualifies state standards both for fraud and continuing-education upgrade. Our programs are adaptable and can be presented in various formats to address industry requirements and standards. Please visit and check our course listings.
Daniel Schweizer

The Koyal Group Private Training Services on Fraud investigation tips from Deloitte's M... - 1 views

  •  
    FierceHealthPayer: Anti-Fraud: What are some early indicators SIUs can watch for signaling that reports of potential fraud, waste and abuse may become significant or urgent cases? Mike Little: Assessing allegations early is a challenge, but taking some specific and general steps can help SIUs determine if a case may become a priority. The first specific step is assessing the allegation. What's involved, and what's the scope of the issue? Could it be part of a larger problem or national scheme with the potential for media attention? Also check if patient safety is at risk. Financial harm at the expense of patients is an area that becomes urgent very quickly. And different case steps are necessary if patient safety issues are involved as opposed to financial issues alone. Are there signs that unlicensed individuals are at work? This can raise questions about your company's credentialing and due diligence processes that affect patient safety. And lastly, determine if employees from your organization may be implicated. That may cause reputational harm and indicate internal control weaknesses. But insurers and the federal government can no longer wait for complaints to arrive because often by then there's been significant loss. So SIUs should also take general steps to spot trends and risks. These steps involve knowledge. First, plug into a healthcare fraud task force. These exist nationwide and include other SIUs and federal and state law enforcers and regulators. These groups are the wave of the future in terms of public and private partnerships. There's a great deal of information shared about what's happening at other companies or in other segments of the community.
Daniel Schweizer

The Koyal Group Private Training Services: Tips and Tools for Insurance Fraud Investiga... - 1 views

The Koyal Group Private Training Services: Tips and Tools for Insurance Fraud Investigations
started by Daniel Schweizer on 26 Jun 14 no follow-up yet
  • Daniel Schweizer
     
    Technology and social media are great tools used to investigate insurance fraud, according to expert panelists who spoke at the recent Risk and Insurance Management Society conference in Denver.

    Susan LaBar, a risk manager for the bus company Coach USA/Megabus, and Scott Catron, senior vice president of Titan Investigative Alliance, provided tips for adjusters investigating suspected insurance fraud.

    LaBar said she regularly gathers comprehensive information on both workers' compensation and general liability claims. When a claim occurs, LaBar requests a detailed, five page report. It contains requests for nicknames, email addresses, hobbies, children's names and hobbies, work history, college information and even pet information. This information helps when it comes time to conduct an internet and social media background investigation.

    Catron discussed several technologies currently utilized in claims investigations. These include 3 D laser scanning, cross referencing multiple databases, mapping claims, remote surveillance and GPS and black boxes. He provided an example where mapping claims helped him discover two claimants that lived on the same street. This helped him when it came time to set up surveillance of the claimants.

    Used to monitor vehicles, GPS and black boxes can be can be programmed to provide tire and off route alerts, according to LaBar. In addition, she said they can help verify whether or not a bus was in an area that a claimant claims an accident occurred. She added that buses outfitted with surveillance cameras can document hop-ons, claimants who hop on to a bus after a crash and claim an injury.

    Catron explained the difference between a surface search and a deep internet search and provided tips on conducting internet investigations. He said a surface search involves using google and other search functions while a deep web search involves searches that lead to other databases, like court websites. Catron described how a deep internet search helped him find a regional race track website that contained damning photos of a claimant.

    The seasoned investigator warned against friending claimants on social networks. He also emphasized the importance of confirming that the correct person is being investigated.

    Sometimes claimants can get creative, they said. During past investigations both have encountered claimants who had two Facebook pages, one with the alleged injury and one without.

    When screen shots are used as evidence, Catron said that it is important to note that whoever takes the screen shot will likely have to appear in court.

    Catron also provided some surveillance tips that adjusters should consider when working with an investigator.

    Adjusters should be aware that investigators:

    *           Can't trespass;

    *           Can't zoom into a residence;

    *           Can't film over a privacy fence;

    *           Can't climb trees;

    *           Must be in public view;

    *           Can't participate in hard following (obvious tailing) because it is considered harassment;

    *           Can't extract information by pretexting or lying about who they are.
Daniel Schweizer

Overholdelse uddannelse materialer - Koyal Group Training Services - 2 views

Overholdelse uddannelse materialer Koyal Group Training Services
started by Daniel Schweizer on 07 Jun 14 no follow-up yet
  • Daniel Schweizer
     


    Main site: http://koyaltraininggroup.org


    Velkommen til OIGS overholdelse 101 webside. OIG udviklet de gratisundervisningsressourcer, der er opført på denne webside kan hjælpesundhedspersonale, praktiserende læger og leverandører forstår de sundhedspleje svigog misbrug love og konsekvenserne af at overtræde dem. Disse overholdelseuddannelse materialer kan også give ideer til måder at dyrke en kultur for overholdelseinden for dit eget helbred omhu organisation.
    Generel overholdelse uddannelse materialer

    Overholdelse af Program retningslinjer

    OIG har udviklet en serie af frivillig overholdelse program vejledninger rettet modforskellige segmenter i sundhedssektoren industrien, såsom hospitaler, plejehjem,tredjeparts-billers og varigt medicinsk udstyrsleverandører, til at fremme udvikling oganvendelse af interne kontrolelementer til at overvåge overholdelse af vedtægter,regler og kravene i programmet. Dokumenterne giver principper at følge når udvikle encompliance-program, der bedst passer til behovene i din organisation. Dokumenterneogså identificere svig og misbrug risici at holde øje med, når du opretter et program.

    Udbyder overholdelse uddannelse

    Overholdelse uddannelse widget nedenfor er links til gratis uddannelse afsundhedspersonale, overholdelse af fagfolk og advokater. OIGS udbyder overholdelseuddannelse var en opsøgende initiativ udviklet som en del af HHSS og US Departmentof Justice's Health Care svig og håndhævelse Action Team.

    Generalinspektør diskuterer betydningen af sundhedspleje overensstemmelse

    Dan Levinson Inspector General Daniel Levinson skitserer vigtigt overholdelsespørgsmål for sundhedspersonale før sundhedspleje overholdelse Association.


    Overholdelse uddannelse materialer til sundhedspleje bestyrelser

    Et mødebord på grund af deres tilsyn ansvar, bestyrelserne har en unik mulighed for atpåvirke deres sundheds organisationer til at fremme kvaliteten af pleje og omfavnelseoverholdelse af lovgivningen. Disse ressourcer kan hjælpe instruktører, der ikke kanvære advokater eller behandlere, skabe en virksomhedskultur, der fremmer høj kvalitetpleje og omfatter overholdelse af lovgivningen.

    Overholdelse uddannelse materialer til læger

    Brochure dække disse undervisningsmaterialer hjælpe undervise læger om de føderalelove der skal beskytte Medicare og Medicaid og programmet modtagere fra svindel,spild og misbrug. Materialerne opsummere de fem vigtigste føderale svig og misbruglove, der gælder for læger og giver tips om, hvordan læger bør være ioverensstemmelse med disse love i deres relationer med betalere, leverandører, ogkolleger læger og andre udbydere.

    Ansvarsfraskrivelse

    Disse undervisningsmaterialer var aktuel på det tidspunkt de blev offentliggjort ogsendt til OIGS websted. De blev udarbejdet som uddannelsesmæssige ressourcer; de erikke beregnet til at skabe nogen rettigheder, privilegier eller fordele. Selvom ethvertrimeligt forsøg er gjort til at sikre nøjagtigheden af oplysningerne i disse materialer,ligger det endelige ansvar for at overholde de føderale svig og misbrug love hosudbyderen af tjenesteydelser. OIG medarbejdere, agenter og medarbejdere giver ingenrepræsentation, garanti eller garanti for, at disse samlinger af oplysninger er fejlfri ogbærer intet ansvar eller erstatningsansvar for resultater eller konsekvenser af deresbrug. Disse materialer er resumeer, der forklarer visse aspekter af de føderale love,svindel og misbrug, men er ikke juridiske dokumenter. De officielle oplysninger erindeholdt i de relevante love og regler.
Daniel Schweizer

Texas Investigated Insurance Fraud Cases in 2013 by Koyal Group Training Services - 4 views

Texas Investigated More than 550 Insurance Fraud Cases in 2013 Koyal Group Training Services
started by Daniel Schweizer on 31 May 14 no follow-up yet
  • Daniel Schweizer
     
    Texas Investigated More than 550 Insurance Fraud Cases in 2013

    Texas Department of Insurance Fraud Unit opened investigations into more than 550 insurance fraud cases in 2013.

    More than $10.3 million in insurance fraud was identified in criminal cases referred for prosecution in 2013, the department said. Court-ordered restitution for cases that reached final adjudication during this same period totaled more than $7.5 million.

    "The amount of insurance fraud committed in Texas is growing and the schemes to make false claims for insurance benefits are becoming more complex," Texas Insurance Commissioner Julia Rathgeber said. "I would like to thank local prosecutors for their diligent efforts to combat fraud with all of the tools available to them. Together, we can build a strong line of defense against these crimes."

    These are the fraud unit's top 10 cases for 2013:

    * Mike Klein filed continuous injury claims with his health insurer after his retirement from the San Antonio Fire Department. Klein forged paperwork from his doctor and supervisor in support of the claims. Klein pleaded guilty to insurance fraud, a second-degree felony. He was sentenced to 120 months deferred adjudication and ordered to pay $2,000 in fines and $117,140 in restitution.

    * George Martinez was employed by multiple employers while he was receiving workers' compensation benefits after being injured at his primary place of employment. Martinez did not notify his workers' compensation insurance carrier of his other employment as required by law. Martinez pleaded guilty to insurance fraud and was sentenced to 48 months deferred adjudication. He was also ordered to pay $2,000 in fines and $7,196 in restitution.

    * Christopher Purser and Robert S. Mills sold fictitious marine insurance to the owner of Shoreline Cruises of Lake George, NY. When the cruise ship Ethan Allen sank and killed 20 elderly tourists, the company was left with no valid insurance coverage. Purser and Mills pleaded guilty in U.S. Federal Court - Southern District of Texas to federal charges stemming from an investigation by the TDI Fraud Unit, the Internal Revenue Service, and the Federal Bureau of Investigation. Purser was sentenced to 188 months in prison. Mills was sentenced to 120 months in prison and was ordered to pay $2.45 million in restitution.

    * In Dallas County, Sylvia Leyva-Talamantes billed Blue Cross and Blue Shield for 110 health claims for services that were not rendered. She received more than $28,131 in benefits from these false claims. Leyva-Talamantes pleaded guilty to insurance fraud, a second-degree felony. She received 120 months deferred adjudication and was ordered to pay $2,000 in fines and $28,131 in restitution.

    * Leslie Ray Collins of Sugar Land, also a former insurance agent whose license was revoked in 2009, collected insurance premiums for fictitious residential and commercial insurance policies that he created. Collins failed to forward the premiums to an insurer to bind valid coverage but instead used the funds for personal benefit. He also obtained premium financing agreements on fake policies and kept those funds. Collins used the funds in a commercial real estate scam that resulted in the loss of several millions of dollars to investors. The Harris County 338th District Court convicted Collins of a first-degree felony of misapplication of fiduciary property with value of more than $200,000 and sentenced him to 12 years in prison. The court also ordered payment of $162,424 in restitution. This case was initiated by a complaint to the TDI Fraud Unit.

    * Olanrewaju "Larry" Omoyele posed as owner/operator of Rose Tree Medical Clinic and caused different attorneys to file false claims with various insurers for treatment of patients allegedly injured in auto accidents. Neither the clinic nor the patients named on the insurance claims existed. Insurers paid a total of $114,382 to either Rose Tree Clinic, the attorneys, or to the people allegedly involved in the accidents. Omoyele went to trial and was found guilty of insurance fraud, a first-degree felony. He was sentenced to 84 months in prison and ordered to pay $131,182 in restitution.

    * Former insurance agent Leon "Randy" Sinclair III of Houston convinced more than 30 elderly customers to liquidate insurance products and other assets and place the proceeds in charitable gift annuity accounts. Sinclair then misappropriated more than $16 million from the accounts. A Harris County District Court convicted Sinclair of first-degree felony misapplication of fiduciary property and sentenced him to 20 years in prison. The conviction followed a 16-month TDI Fraud Unit investigation.

    * Sylvia Vazquez submitted false cancer treatment claims to her insurer, when in fact she had not been treated for cancer. Vazquez pleaded guilty to insurance fraud, a third-degree felony, and was sentenced to 120 months deferred adjudication, 120 hours of community service, and was ordered to pay $50,025 in restitution.

    * Former licensed escrow officer Pearl J. Whitworth of Huffman fraudulently diverted customer funds to a Texas corporation for which Whitworth was the registered owner. Thirteen wire transfers, totaling more than $299,000, were made from the title company business account where Whitworth worked to her personal bank account. She pleaded guilty to first-degree felony theft, was sentenced to 120 months' probation, and ordered to pay the full amount of the wire transfers in restitution. TDI revoked Whitworth's escrow officer license.

    * Richard Trevino, DBA Chiro-Health Inc., billed health insurers for $515,063 of chiropractic services that were not rendered and received $153,536 in reimbursements. Trevino pleaded guilty to insurance fraud, a first-degree felony. He was sentenced to 60 months' probation, 200 hours of community service, and ordered to pay full restitution.
Daniel Schweizer

Koyal Group Training Services, How to prevent fraudulent claims? - 4 views

How to prevent detect and investigate fraudulent claims Koyal Group Training Services
started by Daniel Schweizer on 29 May 14 no follow-up yet
  • Daniel Schweizer
     
    How to prevent, detect and investigate fraudulent claims

    Insurance fraud equates to around £16m every week and £840m a year. The footage below shows a college student noticing water in the reception area and then intentionally slipping over, which resulted in a fraudulent insurance claim.

    Injury claims in the workplace are a prime example of where a fraudulent claim may be made. These arise from an allegation that the organization was negligent, allowed the situation to become dangerous and led to a foreseeable risk.

    A few practical, preventative steps will reduce risk and cut the time, effort and cost of investigations. By implementing a policy of regular inspection, risks will be identified sooner and accidents could be prevented. Ensuring that all inspections are carefully documented means they can be presented as evidence in court if it becomes necessary to defend against charges of negligence. At the very least, you should make every effort to disrupt the activities of the would-be fraudster who thinks that you are a soft touch. Installation of CCTV cameras is an important preventative measure.

    Remember, if you do have a claim against you, act quickly. If you delay, valuable evidence will be lost and lawyers will apply pressure. So much more can be achieved if you keep one step ahead of the fraudster. By putting your strategies in place as soon as possible, you can be ready to deal with the claims quicker, more effectively and more efficiently.

    Consider taking these steps to help detect fraud:

    * Don't delay - this may lead to pre-action discovery proceedings and other increased costs.
    * Visit the scene as soon as possible to obtain your own photographic evidence.
    * Validate every piece of information that is presented to you.
    * Refer suspicious claims to a fraud coordinator for an expert opinion.
    * Check the claimant exists on the electoral role and investigate their living situation.
    * Liaise with regional counterparts to deliver a consistent approach in your prevention and sanctions.
    * Consider visual mapping of claims to see if a pattern emerges regarding the location of incidents and claimants, (e.g. clusters of claims in a particular area).
    * Check for similar handwriting on sketches to track regular claimants or intermediaries.
    * Deploy effective staff training in claim investigation techniques.

    How Zurich Municipal combats fraud in insurance

    At Zurich Municipal, we strongly believe in embedding fraud detection within all areas of claims handling, providing staff with the knowledge and tools to ensure that all suspicious activity is properly and thoroughly investigated. Examples of this include:

    * Zurich has a dedicated Claims Investigation Unit (CIU), a team of 30 professionals who focus on the investigation of suspicious claims, raising awareness amongst staff and customers, and gathering and sharing intelligence.
    * In addition, there are more than 25 full- and part-time fraud handlers and coordinators at our claim-handling sites to ensure that all suspicious claims are referred for investigation.
    * We have a panel of approved suppliers and solicitors who complement the work we do in-house.
    * Training is regularly delivered to all claims staff to make sure they know what fraud looks like and where they should refer the claim to.
    * We will always look to prosecute fraudsters when the evidence exists, working closely with the Insurance Fraud Enforcement Department
    * We contribute to industry initiatives, such as the Insurance Fraud Bureau, to ensure that Zurich is strongly represented.
Daniel Schweizer

Koyal Group Training Services: 5 tips for new parents considering life insurance - 3 views

5 tips for new parents considering life insurance Koyal Group Training Services
started by Daniel Schweizer on 26 May 14 no follow-up yet
  • Daniel Schweizer
     
    Original Source at starherald.com

    Few personal milestones compel someone to buy life insurance coverage like becoming a parent.

    In the event of an untimely death, life insurance can serve as a financial safety net to ensure there's money available to pay for everything from medical bills to a home mortgage and the future college education costs.

    Many Americans have taken steps to line up such a financial cushion.

    At the end of 2012, there were 146.2 million individual life insurance policies in effect, with coverage totaling $11.2 trillion, according to the American Council of Life Insurers.

    Here are five tips for new parents looking to buy life insurance:

    1. LEARN INSURANCE OPTIONS
    Life insurance policies can vary widely, but they generally fall under two categories: Term insurance and permanent insurance, which are often referred to as whole life or universal insurance.

    With term insurance you pay a premium for a set period, commonly 10 years or 20 years, and your policy entitles you to a specific amount of money. Unless the policyholder dies, triggering a payout, any premiums paid are lost once the policy term ends.

    In contrast, whole life insurance policies cover insured individuals as long as they live. These policies also function as savings vehicle. A portion of the premiums paid for the policy are invested to provide a pool of money that the policyholder can access, tax-free, while they're still alive. Such policies are generally more expensive than term life insurance, however.

    Andrew Porter, a certified public accountant in LaFayette, California, advises clients who are new parents to avoid whole life insurance.

    "The cheapest form of insurance, generally speaking, for healthy, young adults is term (policies)," Porter said.

    2. DETERMINE COVERAGE PRIORITIES
    Generally, an insurance agent will help you determine an appropriate coverage amount for the policy by examining some of the key costs your family will have in years to come, such as the cost of child care, education and the mortgage.

    Another approach is to figure out how much income you're expected to earn over your lifetime.

    Still, while it might be tempting to think of life insurance in terms of a dollar amount, it makes more financial sense to tie that amount to a goal, like paying off a mortgage or college tuition, said Porter.

    "If you're going to buy insurance you want to have a specific use for each policy," he said. "It opens the way for insurance agents to oversell insurance that you may or may not need."

    3. BUY A POLICY EARLY
    The cost of life insurance doesn't hinge on your credit rating, savings or assets. It's determined by your age and the results of a medical evaluation that's required every time you seek coverage.

    If you're a couple in your 20s and healthy, you'll pay less than when you're in your 30s and 40s.

    "If you can qualify now it's better to do it, versus waiting and something could change in your medical situation and you may end up not qualifying," said Craig DeSanto, head of life insurance and long-term care at New York Life. "And the younger you buy, the cheaper it is."

    A 20-year-old man who is healthy and doesn't smoke could be charged, on average, $32.53 a month for $500,000 in coverage on a 20-year term life insurance policy, according to an estimate by insurance quote portal TrustedChoice.com.

    By comparison, a 50-year-old with the same health characteristics would be charged $111.38 per month for the same coverage.

    4. CONSIDER INSURING BOTH PARENTS
    It's common for both parents to work and contribute to household expenses and the costs of caring for their children. That's one reason experts recommend both spouses have life insurance, particularly if they both pitch in to pay the mortgage.

    But even in cases where one parent quits work to care for a young child, that parent should be insured.

    "If you're providing for someone it's not just income that you make as an employee, it's the value you're providing taking care of a dependent," said DeSanto.

    5. CONSULT THE PROS
    Wading through the trove of life insurance offerings can be challenging. It's best to consult with a financial advisor and meet with an insurance agent who can provide the most up-to-date rates and policy options available.
Daniel Schweizer

Koyal Group Training Services - Beverly Hills dentist pays insurance fraud restitution - 4 views

Koyal Group Training Services Beverly Hills dentist pays insurance fraud restitution
started by Daniel Schweizer on 20 May 14 no follow-up yet
  • Daniel Schweizer
     


    California Insurance Commissioner Dave Jones, shown in 2011, announced that Beverly Hills dentist Tom Kalili, who pleaded no contest to insurance fraud charges, has paid $786,000 in restitution. (Katie Falkenberg / Los Angeles Times)

    Beverly Hills dentist Tom Kalili has paid $786,000 in restitution for insurance fraud and failure to file tax returns, California Insurance Commissioner Dave Jones announced Friday.

    Kalili, 59, was arrested in May 2012 after a multi-year investigation by the state Department of Insurance, the Dental Board and the California Franchise Tax Board. He owned Beverly Hills Medical Suites.

    Investigators accused him of submitting claims for services not rendered, mainly involving emergency dental procedures.

    Kalili pleaded no contest and was sentenced to one year in Los Angeles County jail and five years of probation.

    "This case is a significant success in our fight against healthcare fraud," Jones said in a statement. "Not only is there one less bad actor on the streets, but those who were owed restitution received it."
Daniel Schweizer

The Koyal Training Group,Tis The Season For Tax Identity Theft - 1 views

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    "Identity Thief" is a 2013 movie starring Jason Bateman and Melissa McCarthy about a woman who steals the identity of a man named "Sandy." After the McCarthy character steals the Bateman character's identity, all types of high-jinx ensue. In real life, identity fraud is a very serious matter that frequently ruins the credit of the victim and takes a great deal of time and effort to resolve. With the 2013 tax filing season starting on January 31, 2014, the season for tax identity fraud is also upon us. Stolen identity refund fraud (SIRF) is a subset of identity theft that involves the criminal stealing the tax "identity" of an individual. Similar to any identity fraud, a criminal committing tax identity fraud obtains key information about the victim. In the tax context, the key is obtaining the individual's name matched with his or her social security number. Once that is obtained, the SIRF thief submits a false tax return in the name of the victim claiming a tax refund. Unfortunately, in many instances the refunds are issued. The fraud may be discovered when the unsuspecting victim files his or her own return and discovers that the IRS will not issue a refund because a return has already been filed under their social security number. It can be very difficult for the individual to get this straightened out with the IRS once the tax identity theft has been committed. Like other identity theft, tax identity theft frequently causes the victim a number of problems including damaging credit ratings, and reducing state or federal benefits. The victims of tax identity fraud are frequently the elderly, or individuals collecting subsistence payments who are not required to file federal income tax returns. For the elderly and those who are not required to file tax returns, it may take much longer for such individuals to discover that they were victims of tax identity fraud. Nevertheless, the fraud may impact those individuals by reducing state or
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