Presentation on theme: "Fraud Prevention & Tools of The Trade Risk Management Agency Special Investigation Branch Senior Investigator Mark Price."— Presentation transcript:
Fraud Prevention & Tools of The Trade Risk Management Agency Special Investigation Branch Senior Investigator Mark Price
Background ßJune 2000 ßThe Agricultural Risk Protection Act of 2000 (ARPA) ßThe Federal Crop Insurance Act (the Act) ßSection 515: Program Compliance and Integrity
Background (C ont.) ßSection 515: Program Compliance and Integrity. ßProvided the Risk Management Agency (RMA) with a nationwide fact-finding network through a formalized alliance with the Farm Service Agency (FSA) ßDirected that RMA and FSA share insured producer data to identify and correct reporting inconsistencies between the programs ßFunded the use of data warehousing and data mining information analysis technologies
Background (Cont.) ßSince June 2000, the principle focus of RMA’s Compliance function has been implementing Section 515 of the Act ßSection 515 required that RMA and FSA form an alliance and, along with the 17 insurance providers, work together to improve program compliance and integrity
Implementation RMA efforts have been focused on: ßTraining FSA and RMA personnel on the new provisions of the Act and resulting procedures ßDeveloping the FSA/FCIC program consultation process through Insurance Services Regional Offices ßEstablishing a process for FSA to assist RMA and the Insurance Providers in an annual claims audit role as part of RMA’s quality-control process
Implementation (C ont.) ßDeveloping procedures for referring potential crop insurance program errors, fraud,waste and abuse between FSA and RMA ßIntegrating the data reconciliation process between FSA and RMA ßInitiating the data warehousing and data mining project
Implementation (C ont.) ßEstablishing a sanctions function to facilitate the imposition of penalties (such as fines, debarments and disqualifications) ßEstablishing a Special Investigations Branch (SIB) to enable more focused and timely responses to high-profile cases that would strain the capabilities and resources of existing RMA Regional Compliance Offices (RCO)
Claims Audit Legislative Requirement ßFSA will assist in auditing a statistically appropriate number of claims paid by insurance providers Milestones ßProcedure published in 4-RM Handbook, FCIC Program Integrity
Data Mining and Warehousing LEGISLATIVE REQUIREMENTS ßInformation technologies known as data mining and warehousing shall be used to administer and enforce Section 121 of ARPA ßDevelop procedures to identify sales agents or loss adjusters who were associated with loss claims that were greater than 150 percent of the mean for the area IMPLEMENTATION ßLet contract to establish data warehouse. ßData Mining project initiated ßSingle step in a multi-step research project
Data Mining and Warehousing ßRESULTS ßIMPLEMENTING PROCEDURES BASED ON ANALYSIS ßTARGETS ATTENTION OF COMPLIANCE EFFORTS ßREFERRALS TO: ßRISK MANAGEMENT AGENCY ßINSURANCE PROVIDERS ßFARM SERVICE AGENCY
RESULTS- Referrals Fiscal Year 2001 results ßSpot Check Referrals ß1763 Referrals sent to FSA ß4-RM Referrals ßReceived 413 referrals from FSA on form AD-2007
NRCO Data Mining Summary
$0 $20,000,000 $40,000,000 $60,000,000 $80,000,000 $100,000,000 $120,000, INDEMNITIES PAID TO INDIVIDUALS ON SPOT-CHECK LIST AS OF 02/10/02
Fiscal Year 2001 ßThe emphasis on prevention has produced promising early results. ßRMA and Insurance Providers have stopped close to $15 million in improper payments from being made in Fiscal Year (FY) 2001, with many more payments still being investigated. ßUSDA and the Department of Justice recovered close to $29 million.
TOOLS OF THE TRADE ßCRIMINAL CODE ß18USC, 1014 – False Statements or Reports in connection with FCIC - $1M Up to 30 Years ß18USC, 1001 – False Statements – Fines/Time
TOOLS CONT. ß18USC, 286 – Conspiracy – Fines/Time ß18USC, 287 – False Claims – Fines/Time ßCIVIL ENFORCEMENT ß31USC, 3801 – False Claims ßAffirmative Civil Enforcement – Treble Damages Plus Fine ($5K-$10k) ß7USC, 1506 Civil Fines and Disqualification
TOOLS CONT. ßADMINISTRATIVE REMEDIES ßCivil Fines ßDisqualification/Suspension of Producers ßDebarment/Suspension of Agents, Adjusters, Company Employees
CRIMINAL/CIVIL PROSECUTIONS Mother and Son – Plead Guilty to Crop Insurance Fraud In Minnesota Criminal Conviction: ßBoth defendants plead guilty to making false statements and conspiring with the processing facility to falsely report the amount of dry bean production and value $$ they received for the dry beans. ßBoth defendants were ordered to pay FCIC restitution totaling $100,330. ßThe son was sentenced to prison for 10 months and supervised release for three years.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Mother and Son – Plead Guilty to Crop Insurance Fraud (Cont.) Civil (Summary Judgment): ßUnder the terms of the civil settlement agreement the son agreed to pay an additional $12,670 and voluntarily disqualified himself from future participation in the MPCI program for a period of three years.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Crop Insurance Company Agreed to Pay Civil Damages and Penalties Civil Action: ßFraudulent MPCI claims were filed by a company loss adjuster on his father’s MPCI policy. The claims were processed and approved by claims managers at the company’s regional office in Fargo, ND. When the company became aware the claims were potentially fraudulent, they did not report the suspected fraud to the Risk Management Agency.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Crop Insurance Company Agreed to Pay Civil Damages and Penalties (Cont.) Civil Action: ßThe settlement agreement requires the company to pay treble damages and penalties of $323,616, implement a corporate compliance plan that establishes a Special Investigative Unit that is independent from the crop insurance claims division, regularly report suspected false claims data to RMA, and provide annual fraud-prevention training to all loss adjusters and SIU investigators.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Four Farmers Are Charged in Crop Insurance and Disaster Payment Case Criminal Indictment: ßThree farmers in North Dakota and one in Minnesota were charged with illegally profiting from $1.8 million in crop insurance and disaster payments resulting from an alleged conspiracy. ßAdditional charges were filed against a Minnesota businessman, who was previously indicted in connection with the scheme.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Four Farmers Are Charged (Cont.) Criminal Indictment: ßAn employee of an Oslo, MN grain cooperative was accused of enticing farmers to sell wheat at a discounted price and allegedly providing false or incomplete information to allow farmers to obtain crop insurance and disaster aid payments. ßA trucking company was also charged with conspiracy and money laundering.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Wimbledon, North Dakota Man Found Guilty For role in $14M Crop Insurance and Farm Program Fraud Scheme Criminal: ßThe North Dakota man, along with his other farm business entities were found guilty of 19 counts of fraud, racketeering, tax and conspiracy charges in federal court in Fargo, ND. ßThe jury ordered the defendant to forfeit $5.9M for money laundering, conspiracy to defraud federal agencies, false statements and filing false tax returns in connection with MPCI and FSA farm program payments.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Wimbledon, North Dakota Man Found Guilty (Cont.) Criminal: ßAccording to the indictment, the man conspired with five other individuals to establish sham farming operations to avoid MPCI and FSA program requirements ßThe sham farming entities were not eligible for crop insurance benefits as they did not actually have an interest or share in the insured crop.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Wimbledon, North Dakota Man Found Guilty (Cont.) Criminal: ßProduction was also shifted between the sham farming operations in order to receive crop insurance indemnity payments. ßEach fraud count carries penalties of up to 20 years in prison. Additional financial penalties will be imposed according to federal guidelines, after the pre-sentence investigation is complete.
CRIMINAL/CIVIL PROSECUTIONS (CONT.) Wimbledon, North Dakota Man Found Guilty (Cont.) Administrative Action: ßThe defendant is a crop insurance agent in North Dakota. The North Dakota Insurance Department has served a Cease and Desist order and filed an administrative complaint to revoke the his agent’s license. ßRMA has suspended the defendant thereby, excluding him from participating in the Federal Crop Insurance Program, as an insured, agent, owner of an agency selling crop insurance or any other capacity.
ANTI-FRAUD TRAINING THE FIRST LINE OF DEFENSE ßVIDEO ßCLASSROOM TRAINING ßTRAINERS/FACILITATORS ßCD ROM ßCOMPUTER BASED/SELF-PACED MODULE ßCURRICULUM ßFRAUD INDICATORS ßINTERVIEWING TECHNIQUES ßOBTAINING INFORMATION