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Presentation on theme: "FCI INVESTIGATIONS WHERE VIDEO AND INFORMATION ARE KING!"— Presentation transcript:


2 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.”

3  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

4  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


6  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

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

8  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

9  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

10  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

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

12  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

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

14  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

15  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

16  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

17  AOE/COE Investigations$75.00 per hour  EUO$75.00 per hour  Surveillance$560.00 per day  Neighborhood Canvasses$200.00 Flat Rate  Background Investigations$80.00  SIU/File Review$700.00  DIF Submittal$700.00  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$600.00 Flat Rate per day  Alive and Well Verifications$200.00 Flat Rate

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

19  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

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

21  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

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

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


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