FCI INVESTIGATIONS WHERE VIDEO AND INFORMATION ARE KING!

Slides:



Advertisements
Similar presentations
EMPLOYMENT AND LABOR LAW ISSUES IN THE CONSTRUCTION INDUSTRY Presented by: Gary Trobe February 28, 2006.
Advertisements

Thank you for taking a moment to learn more about our services Our People Make the L & W Difference.
DaZee Hotels (Management & Allied Services)
© eComScience Pvt. Ltd OffshoreSoftwareDevelopment eComScience Consulting perspective.
INADEQUATE SECURITY POLICIES Each covered entity and business associate must have written polices that cover all the Required and Addressable HIPAA standards.
XTRA Translation Services learning about XTRAs partnership approach.
 A color queue management system. Customer Segments Large Health Institutions. Hospital chains, health organizations, management groups. Medical Clinics.
Claims Management Program Overview
Licensed Private Investigators and Claim Adjusters. THE SIU GROUP appreciates the opportunity to serve you! SIU INVESTIGATIVE SERVICES
ART Security Pty Ltd S E C U R I T Y P R O F E S S I O N A L S The Age of.
Pharmaceutical Care Solutions 8 March 2010 © Copyright ESH 2010 Submission to Greek Ministry.
FAIR AND ACCURATE CREDIT TRANSACTIONS ACT (FACTA)- RED FLAG RULES University of Washington Red Flag Rules Protecting Against Identity Fraud.
Intellithoughts. Intelli Thoughts. Smarter Solutions! Our Mission We will be a partner of choice for offshore based Small to medium scale Enterprise Solution.
Metro Security Force Inc. “Protecting you and your property”
JOB FUNCTION EVALUATION Lowering Your Accident Costs.
© Chery F. Kendrick & Kendrick Technical Services.
Executive Overview Executive Overview  Incorporated in June 1999  Two Core Product Areas Investigative Services Litigation Support / Records Acquisition.
DATA SECURITY Social Security Numbers, Credit Card Numbers, Bank Account Numbers, Personal Health Information, Student and/or Staff Personal Information,
WHAT… Myrket is a B2B online advertising agency focused on e-marketing services; Main Services: e-marketing strategies; website development; search engine.
Center for Health Care Quality Licensing & Certification Program Evaluation 1 August 2014 rev.
Initial Findings  Secure all contracts with third party vendors immediately  Develop a strong understanding of the ‘Flow of PHI’ within and outside of.
April A free, unbiased service, sponsored by the: Statewide Health Insurance Benefits Advisors (SHIBA)
Forensic Accounting. Agenda Definition History Skills Business scandals Cases.
JOBS IN IT.
Career number 1. E- Discovery Professional  Electronic Discovery- Technology based Identifies, preserves and manages electronically stored information.
Workers Compensation Case Management Iris Ayala Occupational Health Manager Kaolin Mushrooms April 2011.
Private Detective & Investigator Quristain Hand. What Do They Do? (Duties)  Interview people to gather information  Do various types of searches, using.
Updated | 5/9/2012 Retiree Choices New Choices Better Value New Coverage New Approach to Health Care Coverage.
STAT Transcriptions May STAT Transcriptions Profile We are Healthcare BPO with Transcription and Coding services. Who we are What Are Our Capabilities.
Introduction to Business Organisations
Incident Reporting Procedure
FSD Solutions Medical Transcription Services FSD Solutions.
Skywalker Product Network Business Plan. Mission Statement  Skywalker Product Network, is going to change the way people shop on the internet. We intend.
Solution Overview for NIPDEC- CDAP July 15, 2005.
Data Processing Capabilities
University of Idaho Business 378 – Project Management Yoshi Pitkin.
SURVEILLANCE SYSTEM HITRON DVR All rights reserved by Hitron Systems.
Chapter 13 Security Permission granted to reproduce for educational use only.© Goodheart-Willcox Co., Inc. Objectives State the major responsibility.
Fire Investigation Services. Key Strengths 2 Today’s Presentation Company Background 1 Project Portfolio 3 Why EFI Global 4.
Disasters know no geographic or seasonal limitations  Earthquakes  Wildfires  Floods  Tornadoes  Hurricanes  Pandemics  Terrorism  Bioterrorism.
22/9/ About Company Business Portfolios IT Solutions BPO Services Business Approach How we can Help Advantage of Outsourcing Why Crystal Business.
How Hospitals Protect Your Health Information. Your Health Information Privacy Rights You can ask to see or get a copy of your medical record and other.
1. Objectives  Describe the responsibilities and procedures for reporting and investigating ◦ incidents / near-miss incidents ◦ spills, releases, ◦ injuries,
Modified Duty Closing the Claim. Overview  Elements of an effective Modified Duty Program  How to implement a successful program.  Branch level roles.
Stakeholders In Clinical Research The Pharma Company Professor Phil Warner.
ETHICAL BPO SERVICE Business Profile. ABOUT EBS BPO service provider in the Healthcare sector. Focus on Medical Transcription Services. Established in.
Element 2 Promote the organization and the IT department.
R ed F lag R ule Training for the Medical Industry © Chery F. Kendrick & Kendrick Technical Services.
Copyright © Education Compliance Group, Inc. All rights reserved. By Peggy A. Burns, Esq. and Mark Hinson, SPHR Internal Investigations & Decision-Making:
℠ Pryvos ℠ Computer Security and Forensic Services May 27, 2015 Copyright © 2015 Pryvos, Inc. 1.
Clinical Application. The Problem Clinical Systems are extremely complex IT configures and deploys best practices (best guesses) about what users want.
Cleve L. Freeman – Los Angeles, CA USA Energy Loss Reduction Programs & Profits, Rio de Janeiro, Brazil 11 – 13 August 2004.
Aetna Special Investigations Unit Alaska Health Care Commission June 19-20, 2014.
Workers Comp Overview & Accident Investigations
Welcome….!!! CORPORATE COMPLIANCE PROGRAM Presented by The Office of Corporate Integrity 1.
Hospitality Operations Objective 3.04 Security. Objective Security  State the major responsibility of the Security Department The protection of.
Zenith+MD ZenithMD Medical Services since Front Office Systems Back Office.
Security Task at Texas A&M University By: Savannah Drazkowski Zac Stables.
Protecting Yourself from Fraud including Identity Theft Personal Finance.
Immediate Issues & Tasks after the discovery of Occupational Fraud March 17, 2016.
Are you really protected against all Risk and liabilities? Are you sure that your Security Company have: Liability Insurance covering up to $ 2, ?
Statewide Health Insurance Benefits Advisors (SHIBA) June 6, 2016.
Quality Health Claims Consultants, LLC City of Joliet Dependent Verification Audit Proposal.
Incident Reporting And Investigation Program
Preferred Resale Partner Proposal for Starwood Vacation Ownership Inc.
Introduction The Regional Computer Forensics Laboratory (RCFL) National Program Office created this toolkit to help law enforcement executives assess.
Incident Reporting And Investigation Program
Cross Training in the Criminal Investigation Division…
Protecting Your Claim After a Car Accident
Presentation transcript:

FCI INVESTIGATIONS WHERE VIDEO AND INFORMATION ARE KING!

OUR MISSION “Our mission at FCI is to be at the forefront of the investigative industry with getting results and being your partner in fighting fraud. We are a results driven company. We offer cost containment solutions for our clients. At FCI you can be assured that all of your investigative needs will be met. Our focus will be to handle your investigative needs from your initial contact to the complete resolution by strong focus on customer service, investigative expertise and RESULTS.”

 SIU RAPID REACTION TEAM  AOE/COE Investigations  SIU/File Review and DIF Submission  EUO  Fatality  Scene Investigations  Statements and Interviews  Clinic Investigations  Theft & Property  INVESTIGATIVE TEAM  Surveillance  Neighborhood Canvasses  Background Investigations  Hospital and Pharmacy Verifications  Alive and Well Verifications

 Combat Fraud on the front end  Initiate within 24 Hours  Secure statement before they “lawyer up”  Speak with witnesses before they “disappear” or forget  Photograph scene  Secure evidence  Determine Subrogation  Sets up for future surveillance

FCI, YOUR PARTNER IN SIU

 Review of Field Notes  Review of Surveillance tapes  Review of Doctor Notes  Review of Depositions & EUOs  Review of Statements  Determine if there is proof of intent  Determine if further investigation is needed  Determine if any inconsistencies within the file

 Write Summary of Analysis  Organize File Material  Meet with Officer assigned to file  Following up  Report outcome of submission

 Florida law requires that all licensed insurers and health maintenance organizations establish a special investigative unit and/or file an anti- fraud plan to the Division of Insurance Fraud.  FCI can partner up with your existing SIU team

 Claim Investigation Services  Fraud Detection & Prevention  On Site Consultation with Established Office Hours  Fraud Feasibility Analysis & Reviews  State Fraud Referrals  State Compliance & Reporting  Toll Free Fraud Hotline

 Evidence, medical report, video surveillance, documentation  Deposition – key to lock down testimony so that they can’t recant their statement (invaluable tool to use following surveillance or receipt of prior medical complaints & treatment  Organized case to present to the Department of Insurance Fraud – the file “needs to speak for itself” – include First Report of Injury, Transcribed Statements, Medical Records, Depositions

 Why do it?  Why it works  How it works  How often?

 Profile Case  Social Media Search  Assigned to the field  Vary up times  Communication between Managers and Investigators  Communication back to the adjuster or SIU  Recommendations

 Investigative Staff  Management  Better Customer Service  Pricing  No Sub-Contractors

 We build from the ground up – our investigators are our product  Good pay, benefits, video bonus program = RESULTS  Evaluated on a Metric performance system of stats and time service  Other companies build from marketing – sell, sell, sell

 Managers promoted from the field  Manage on average only 8 investigators  Constant communication with the investigators  Continuously strategizing cases  Working smart – varying up times  Profiling

 We deal directly with the adjuster or SIU  They get a better feel for their cases  No middle man like sub-contractors  Biggest Complaints  Home/No Activity – FCI gets information  No suggestions or recommendations  Lost at light  They worked it 6AM to 2PM every day!  Not letting adjuster know if case is burned  FCI works budget smarter  Don’t eat up budget by sitting the mandatory 4 hours  Getting results cuts down on exposure

 AOE/COE Investigations$75.00 per hour  EUO$75.00 per hour  Surveillance$ per day  Neighborhood Canvasses$ Flat Rate  Background Investigations$80.00  SIU/File Review$  DIF Submittal$  Scene Investigations$75.00 per hour  Statements and Interviews$75.00 per hour  Hospital Verifications $99.00  (up to 24)  Pharmacy Verifications$99.00  Clinic Investigations$ Flat Rate per day  Alive and Well Verifications$ Flat Rate

 No “middle-man”  Investigators are managed by our managers  It all goes back to communication

 We have a dedicated Linux based web-server  Our software developers have modified the Cent-os Linux key components to heighten security  We are behind a double-NAT managed Watch Guard firewall which is hardware based  Capability of sending video & statements electronically

 Secure Access to your cases, files & videos  Assigned log in and password

 Multilingual – Spanish, Creole, Arabic, Portuguese, German, and Hebrew  Experienced SIU Team  All staff can communicate electronically through computers and blackberrys  State of the art video cameras  Digital and micro-cassette dictation equipment  Digital Cameras  Inside video equipment  Well maintained vehicle

 Evidence is stored in a secured, locked, climate controlled evidence room in our office  Additionally, evidence is stored electronically

 Normal turn around is 10 – 14 days  Can turn around in 24 to 48 hours  Five tier Q & A process on reports and video