Ethos Blog

Improvise and Thrive

So the Little League World Series is in full swing. And once again, I’m hooked. As someone who’s spent half his professional life as a sportswriter, I thoroughly enjoy this event. Truly, it brings back great memories. During my days with a scorebook and reporter’s pad, I loved covering youth sports. For starters, Little League parents had not yet blossomed into self-appointed experts and therefore voiced less complaints—or at least voiced said complaints at lower decibel levels—than their high school peers. More than that, though, seeing those light bulb moments unfold was magical. You cannot help but smile when a No. 9 hitter digs in, keeps his eye on the ball, and WHACK—delivers a single up the middle. Those kids on ESPN are clearly more accomplished than most of the youngsters I wrote about. Their skill-sets are amazing, especially for this age. The big mind-boggler, though, is their ability to read, analyze, and react. Not only do they have a solid handle on traditional game situation decisions, their ability to improvise based on opposing personnel and organic developments is stellar. That same quality is vital in fighting fraud. My first job in this industry was in background verifications. During week one, they handed me a list of questions to ask a job candidate’s former employer. One question involved whether the employee left voluntarily or was fired.  The next queried whether said employee would be rehired if his/her position was open. On my first call, the employer told me our subject had been terminated. However, he noted that said subject would be rehired if there was a vacancy. I asked... read more

The 360-Degree Approach To Fighting Fraud

When every physical and mental resource is focused, one’s power to solve a problem multiplies tremendously.”  – Norman Vincent Peale    In order to significantly impact fraud, it is essential to formulate a solid, comprehensive approach. After all, you don’t bring a knife to a gun fight. If you’re smart, you bring a bigger gun and maybe a hand grenade. When it comes to fighting fraud, we really need all the weapons we can gather. I have an approach called the 360-Degree Fraud Program. Personally, I think it makes sense to attack fraud in three segments: 1) Fraud Prevention – preventing fraud before it even happens. 2) Fraud Detection – identifying fraud in an efficient manner. 3) Fraud Defense – fighting fraud once you have the proper evidence. These three components are critical to eliminating, or at the least, significantly reducing fraud. Quite frankly, without addressing all three of these areas you are limiting your ability to successfully combat fraud. All three facets of this approach need to be solid in order to come full circle—full circle as in 360 degrees. As we have already learned, fraud costs the insurance industry billions of dollars each year and it is simply not good enough to combat fraud without taking this three-pronged approach. The adage that you are only as strong as your weakest link certainly applies in this fight. This is how the 360-Degree Fraud Program works: Phase 1 – Fraud Prevention – Identifying potential fraud before it happens can save insurance companies millions of dollars. Dare I say, with a Dr. Evil voice, “Even billions of dollars.” Industry studies... read more

Be your own Sleuth – But don’t cross the line

“The truth. It is a beautiful and terrible thing, and must therefore be treated with great caution.” – J.K. Rowling Thanks to the Internet, there are thousands of informational resources available that if you are so inclined allow you to handle some of your own pre-investigative sleuthing.  For example, a simple Google search on your subject may provide invaluable information regarding said subject’s employment status, hobbies, or sports-related activities.  Checking someone’s Facebook or other social media sites typically reveals a slew of relevant information.  There is a caveat though; you need to make sure you are conducting these investigations in an ethical manner.  No false friending claimant’s on his or her social media sites.  A good rule of thumb is that if information is available to the general public then it is fair game.  If the information is not available to the general public at large and you have to come up with some sort of different way to garner the information than most likely you are stepping on the slippery slope of invading someone’s privacy.  At Ethos we have compiled a long laundry list of viable search engines that can provide a plethora of information on the subject you are researching.  (For a complete list of useful investigative web sites, feel free to send an email to info@ethosrisk.com) Again we caution you to not push the boundaries, but rather conduct all of your research in a professional and ethical manner. My first boss once told me to do everything in the investigative process with the notion that at some point you will be in front of a judge... read more

Got Fraud?

In order to submit a fraud referral it’s important to have good understanding of what fraud truly is. In some cases you may have a claimant abusing the system, but this does not necessarily mean they are committing fraud.  Fraud is commonly understood as dishonesty calculated for an advantage.  Merriam-Webster dictionary defines fraud as, the crime of using dishonest methods to take something valuable from another person.  Fraud may also be made by an omission or purposeful failure to state material facts, which nondisclosure makes other statements misleading. As it relates to insurance fraud there are various elements that need to be proven for a successful fraud conviction. An easy way to determine if you have a case that meets the criteria for fraud is to think of the milk campaign, Got Milk?  You have probably seen these commercials or television ads where celebrities or athletes have a milk mustache and the tag line is, Got Milk?  So think of Got Milk, when dealing with fraud except use the below defined acronym for milk to see if you have the 4 elements that are generally required for a successful fraud prosecution.  Let’s take a look at the acronym and how it’s used to identify potential fraud: M –         Material misrepresentation I –           Intent to deceive L –           Loss – a loss or damages occurred as a result of the fraudulent activity K –          Knowledge.  The subject had knowledge that their statements or actions were untrue. Let’s look at each one of these a little more in-depth. Material Misrepresentation – A material misrepresentation is deliberately hiding or falsifying a... read more

Seasonal Surveillance…What a Feeling

When people ask what I do for a living, I explain that I work in risk mitigation. More often than not, I’m met with a quizzical look followed by the question, “So you’re an attorney?” To avoid an extended narrative detailing the industry ins and outs, I generally choose the most entertaining element of the job. “No, not an attorney,” I say.  “We investigate stuff like fraud.” Most people are very interested when I mention words like fraud and surveillance, especially when I hit them with my favorite investigative stories.  As a communications associate at Ethos, and serving in the same capacity with other companies for a decade or so, I’ve reviewed thousands of investigative reports. I’ve seen dancers with back injuries, construction workers with bum shoulders, and even a dancer working construction. Okay, I never saw that. Unless you count “Flashdance.” Unlike that perky steel town girl, our claimants have far less noble goals than attending an esteemed dance academy.   Which brings me to the gist of this blog. With the weather warming nationwide, fraudulent claimants are ripe for the picking. I can say with 100-percent certainty that spring and summer surveillance reaps many rewards for our clients.  For whatever reason, when the sun shines brightly across crystal blue skies, claimants get careless. Landscaping, beach volleyball, boat outings, 5K runs, softball games…I’ve read it all. Truly, warm weather surveillance is one of the few locks in an unpredictable industry. Don’t assume infallibility, however. That doesn’t exist. However, the odds at this time of year are certainly in your favor. And trust me. When you receive that DVD or video link with an hour-plus of damaging video, you’ll be singing “What a Feeling” all the... read more

Serpico, the wise king, and the BP oil spill

One of my favorite movies growing up was “Serpico.” Starring Al Pacino, it’s a true life story about a New York police officer, Frank Serpico, who went undercover to expose corruption in the police force. Serpico was an honest cop trying to do the right thing, but he was harassed and threatened by his peers. The struggle led to infighting within the police force and problems in his personal relationships. In one compelling scene, Serpico tells a fable he calls “The Wise King.” It’s a story about a king beloved by his people. In the middle of the kingdom there was a well from which everyone drank. One night, a witch poisoned the well. The next day, everybody drank from the well except the king. The people, aside from the king, went crazy, committing crimes and creating chaos. Observing this behavior, the king approached his subjects and reprimanded them. He demanded they change their behavior. The citizens who once loved the king became irate and accused him of acting crazy. They came together and made a pact to kill the king. Clearly, in their minds, he had gone mad. The king feared for his life. Later that night, he drank from the well and immediately went insane. Upon seeing the crazed king the next day, all the people rejoiced because their beloved king had regained his reason. This scene hit me like a ton of bricks when I was a kid. It may have had something to do with my decision to become a fraud investigator. Well, either that or Magnum P.I.’s lifestyle. In any event, “The Wise King”... read more

There is no such thing as a free lunch

I was speaking with one of our clients recently. He mentioned that he received an email from an investigative company that was offering surveillance services for free if they failed to obtain results.

In the advertisement, results equated to obtaining videotape documentation of the claimant.

Tongue firmly planted in cheek, said client asked me if Ethos could make him the same proposal. He laughed, of course, fully aware of the slippery slope involved here.

read more

AICPA SOC LogoExpert Service ProviderEthos Risk Services | T: 866-783-0525 | F: 866-695-9645 | email: info@ethosrisk.com | P.O. Box 55246 | St. Petersburg, Florida 33732 | www.ethosrisk.com