Information Technology Solutions

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1 Information Technology Solutions GA IASIU 2015 Annual Insurance Fraud Seminar PL A TI NU M S PON S OR S Risk Jockey Waldon, Adelman, Cartilla, Hiestand & Prout Unified Investigations March 17, :00 AM 3:00 PM Cobb Galleria Atlanta, GA Sponsor opportunities available GO LD S PO N SO RS Sponsor opportunities available CHAPTER OFFICERS Jim Hammonds President Jill Treadwell Vice President Jonathan Morgan Secretary Emily Stuckey Treasurer BOARD MEMBERS Andre Sullivan Tara Rotthoff Carl Bocchicchio Klye Cravey Fraud Topics Behavioral Symptom Analysis (interviews/interrogations) Lock Analysis/Auto Theft Utilizing Social Media Investigations to Combat Insurance Fraud Changes, Loopholes and Differences with ICD-10 Avoiding the Trap of 3rd Party Contractor Fraud $40 if registered before February 20 $20 for law enforcement $55 at the door (not guaranteed a lunch) Register online at: 4.5 hours POST and CE credit available IASIU is a non-profit organization of insurance professionals, law enforcement, fire investigators, and other individuals dedicated to: Promoting a coordinated effort within the industry to combat insurance fraud. Providing education and training for insurance employees and law enforcement officers. Developing a greater awareness of the insurance fraud program. Encouraging high professional standards of conduct among insurance investigators. Supporting legislation that acts as a deterrent to the crime of insurance fraud. Encouraging members in the development and implementation of programs designed to facilitate the coordination and cooperation with law enforcement and criminal justice agencies in the investigation and prosecution of insurance fraud crimes.

2 GA IASIU 2014 Annual Insurance Fraud Seminar 7:30 Registration Desk Opens 8:15 9:00 Annual Chapter Business Meeting and Award Presentations M a r c h 1 7, :00 AM 3:00 PM C o b b G a l l e r i a 2 Galleria Pkwy SE Atlanta, GA R egis t r ati on $40 before 2/20/2014 $55 at door (lunch not guaranteed) $20 Law Enforcement 9:00 9:30 Break and trade show 9:30 11:30 Behavioral Symptom Analysis Presented by: Tom Davis President & CEO, Insight Training Services LLC Adjunct Instructor, GA Law Enforcement Command College GBI Special Agent in Charge (retired) This course is designed to familiarize and refresh investigators with techniques of detecting deception while conducting interviews. Verbal, paraverbal, and non-verbal indicators of deception will be discussed as well as methodology for accurately prompting and interpreting responses. The course will cover conscious/sub-conscious communication; Obstacles to detecting deception; Methodology/stimulus questions; verbal, para-verbal and non-verbal communication. For more information please visit us on the Web at: 11:30 12:30 Trade show and lunch break 12:30 1:30 Breakout, attendees must select one of the following Session A: Lock Analysis/Auto Theft Presented by: Tim Smith, IAAI-CFI, CFEI, CVFI Unified Investigations & Sciences This course will focus on vehicle theft, lock analysis and deterrent systems including the transmission shift interlock, steering lock, on-board computers what information they store. Session B: Utilizing Social Media Investigations to Combat Insurance Fraud Presented by: Katie Andrews G4S This course will cover several aspects related to the reality of using social media for the investigation of suspected insurance fraud. Topics included will include, but not be limited to: Impact of Social Media, Privacy concerns, Uses in Investigation, Uses in Litigation, Case Studies and how to best use the results. 1:30 1:45 Break and trade show

3 2:00 3:00 Breakout, attendees must select one of the following Session A: Changes, Loopholes and Differences with ICD-10 Presented by: Dr. Rick Wakefield, JD, DC, PA President & CEO, International Healthcare Consultants The new ICD-10 diagnostic codes should go into use in October These codes are much more specific than the ICD-9 codes and will be very useful for the analyst collecting Big Data. However the ability for the provider to game the billing system will increase directly with the complexity of the new code set. An understanding of the coding game is a necessary skill for the medical fraud investigator. Payments will still be based on the old CPT code sets and understanding the relationship between the CPT (procedure) codes and the ICD (diagnostic) codes is essential for developing a fraud case. Session B: Avoiding the Trap of 3 rd Party Contractor Fraud Presented by: Robert Luskin Goodman McGuffey Lindsey & Johnson, LLP This course will focus on 5 specific areas related to contractor fraud. This Issue Did Not Appear Overnight will focus on understanding the situations and facts as well as how early evaluations and getting the right people on the job can be beneficial. The Real World of What Happens in the Field will discuss how the contractors are called, the use of preferred vendors, company policies for dealing with vendors and why to expect predictability and honesty. Also discussed will be the many faces of contractor fraud and overbilling, prevention methods and options for fighting the fraud once it is discovered. 3:00 Closing ceremonies Presentation of certificates

4 Tom Davis President & CEO, Insight Training Services LLC Adjunct Instructor, GA Law Enforcement Command College GBI Special Agent in Charge (retired) Tom Davis recently retired as the Special Agent-in-Charge of the GBI Regional Office in Milledgeville, Georgia. A majority of his 31 year career with the GBI focused on conducting and supervising complex criminal investigations. He specializes in the areas of crime scene examination and reconstruction, sexual assault, interviews and interrogations, and death investigations. He has a BS Degree in Criminal Justice from Georgia Southern University and a Master s Degree in Public Administration from Columbus State University. He is a graduate of the Georgia Law Enforcement Command College and currently serves as an Adjunct Instructor for that entity. He is the owner of Insight Training Services LLC, a company that provides training to law enforcement officers and investigators. Robert Luskin, Managing Partner Goodman, McGuffey, Lindsey & Johnson Robert Luskin is a partner and an experienced trial lawyer in the Atlanta office who represents clients in a wide range of insurance matters and employment litigation in Federal and State Courts across Georgia and the Southeast. Robert has experience in defending corporations and individuals in various complex litigation matters as well as extensive experience in the areas of products liability, premises liability, professional negligence, questionable insurance claims and other insurance coverage matters. Robert also represents various companies with regard to employment related matters including discrimination and harassment issues. He is a graduate of Centre College (B.A., 1998) and Mercer University (J.D., 2001). Robert is active in the American Bar Association; Atlanta Bar Association (Litigation Section); State Bar of Georgia; the Tennessee State Bar, the Atlanta Volunteer Lawyers Foundation and serves as a Guardian ad Litem. Robert is a founding member of Georgia s chapter of the National Society of Professional Insurance Investigators and serves on the Georgia Chapter s Executive Board. Robert has also been recognized by Atlanta Magazine as a Georgia Rising Star Super Lawyer from 2008 to the present. He is a presenter at the National PLRB Seminar, IASSIU, NSPII, CLM, and may other national and regional seminars. He serves on the steering committee of DRI Employment Labor and Law committee. He currently serves as President of the Atlanta Chapter to CLM. In addition to his professional pursuits, Robert has been actively involved since 2002 in the State Bar of Georgia s High School Mock Trial Competition as an attorney coach for Milton High School.

5 Katie Andrews G4S After graduating from North Carolina State University, Katie Andrews started her career with G4S Compliance & Investigations as an Assistant Case Manager where she gained valuable experience directing investigators, interacting with clients, conducting background checks and developing investigative objectives. In January 2012, she was promoted to Regional Account Manager where she oversaw all accounts throughout Maryland, Virginia, North and South Carolina. In July of 2013, Katie became the Sales Team Leader, mentoring and training all new account managers for the southeast region. She also developed training presentations on social media investigations which she has presented to numerous clients and at regional chapter meetings throughout the southeast. In July of 2014, she was promoted to the Southern Region Sales Manager and now oversees a team of Account Managers spanning from Virginia to Florida out to Texas. Her emphasis is on leading a customer-focused team through communication, training and industry expertise. Timothy M. Smith, IAAI-CFI, CVFI Senior Investigator/ Forensic Locksmith Unified Investigations & Sciences Investigative Locksmith, July 2013, 16 hours (Tested) Fire Investigators of Florida, Annual Training Conference, June 2013, 24 hours (Tested) Basic Locksmith, May 2013, 48 hours (Tested) OSHA Hazwoper, Compliance Solutions, March 2013, 40 hours (Tested) Alabama Arson Investigators Association, Annual Training Conference, October 2012, 24 hours, (Tested) Asbestos Operations and Maintenance, January 2012, 16 hours (Tested) Georgia Fire Investigators Association, Southeastern Annual Training Conference, August 2011, 26 hours, (Tested) Georgia Fire Investigators Association, Southeastern Annual Training Conference, August 2010, 26 hours, (Tested) International Association of Arson Investigators, Effective Investigation & Testimony May 2010, 3 hours, (Tested)

6 Dr. Rick Wakefield JD, DC, PA Dr. Rick Wakefield is the President and Founder of International Healthcare Consultants, Inc., an Independent Review Organization and forensic consulting firm specializing in matters involving healthcare, insurance, science and law. For over 25 years he has been a lecturer, teacher, expert witness and consultant in the areas of medical billing and coding, fraud detection, injury causation, biomechanics and human factors. During that period he has analyzed thousands of cases and conducted research concerning causation and human factors in minor to catastrophic injuries and fatalities, and is court qualified as a biomechanical engineer and injury causation expert. Dr. Wakefield has been a consultant to and/or provided training for many Federal, State and Local Government agencies including the Department of Justice during the Clinton, Bush and Obama administrations, the North Carolina Department of Justice, Missouri Attorney General, Idaho Department of Insurance, Florida Medicaid program, State of Arkansas Department of Workman s Compensation, Ohio Department of Insurance, State of Louisiana Employee Benefits Program, State of North Carolina University Medical School System, State of Georgia University System Medical Schools self-insurance program, Palmer University, United States Department of Justice Office of Attorney General, State of California Department of Insurance, U.S. Department of Health and Human Services, and Internal Revenue Service(IRS). He has also been a consultant for State and local Law Enforcement from the Philadelphia Police Department Special Task Force on Insurance Fraud, New York State Police Department, New Jersey Office of Insurance Fraud Prosecutor, Washington State Department of Insurance, Massachusetts Insurance Fraud Bureau, Utah State Attorney General s Office, Utah Division of Occupational and Professional Licensing, Florida Department of Insurance, and Florida State Attorney General s Office. Dr. Wakefield has provided Continuing Legal Education courses in states around the country including being a CLE instructor State Bar of Georgia Insurance Law Institute. He is a member of the Medical Advisory Group and has provided training to industry groups including the National Insurance Crime Bureau (NICB), International Association of Special Investigation Units (IASIU), Florida Insurance Fraud Education Committee (FIFEC) and New Jersey Special Investigators Association (NJSIA). Additionally, he has provided training for and/or worked as a consultant to the U.S. Postal Inspection Service, United States Secret Service, and the Federal Bureau of Investigation. Dr. Wakefield was an associate professor at Life University in the Clinical Sciences Division, Diagnosis Department. Courses taught include: physical examination, special senses, visceral diagnosis, urologic pathology, urinary diagnosis, rectal and pelvic examinations, physiology, and clinical diagnosis. As a clinical instructor and adjunct faculty at the Yale and Emory programs, Dr. Wakefield taught surgical procedures, wound healing and surgical closure, operating room procedures, surgical patient assessment and surgical technique including instrument use.

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