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