Special Investigation Units (SIUs)
Many insurance companies have established special investigation units (SIUs) to help identify and investigate suspicious claims; some insurance companies outsource their units to other insurers. In 1999, 40 percent of property/casualty insurers had SIUs, according to the Coalition against Insurance Fraud. By 2001, that proportion had more than doubled.
These units range from a small team, whose primary role is to train claim representatives to deal with the more routine kinds of fraud cases, to teams of trained investigators, including former law enforcement officers, attorneys, accountants and claim experts to thoroughly investigate fraudulent activities. More complex cases, involving large scale criminal operations or individuals that repeatedly stage accidents, may be turned over to the National Insurance Crime Bureau (NICB). This insurance industry-sponsored organization has special expertise in preparing fraud cases for trial and serves as a liaison between the insurance industry and law enforcement agencies. In addition, it publicizes the arrest and conviction of the perpetrators of insurance fraud to help deter future criminal activities. Insurance company surveys confirm that SIUs dramatically impact the bottom line of many insurance companies.
In the mid-1990s insurers said that for every dollar they invested in antifraud efforts, including SIUs, they got up to $27 back, but these returns have become harder to achieve as the more apparent fraud schemes have been uncovered and more effort is necessary to ferret out the sophisticated fraud that remains. A 2000 study by Conning Research & Consulting suggests that results vary widely. Using the ratio of “claims exposure reduction” to the expense of running SIUs, the study found ratios ranging from a low of 3 to 1 to a high of 27 to 1, depending on the year and line of insurance. Although some insurers are cutting back on fraud investigation by outsourcing investigations and dissolving their fraud units, advances in software technology, especially programs that sift though the millions of claims that large health insurers process annually, are proving effective in fighting fraud. These “data mining” programs can uncover repetitions and anomalies and analyze links to fraudulent activities or entities.
