department of financial servicesflghc.org/ppt/2014/workshops/ws128 fraud fighters... · public...

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Geoffrey R. Branch, Operations MajorFlorida Department of Financial ServicesDivision of Insurance FraudPh: 954-958-5444Geoffrey.Branch@MyFloridaCFO.com

Department of Financial Services

DIVISION OF INSURANCE FRAUD

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Created in 1976

Charged with investigating any and all insurance fraud in Florida:

AutoHealthPropertyLifeWorkers’ Compensation

Accredited by the Commission for Florida Law Enforcement Accreditation (CFA) in February 2009

DIVISION OF INSURANCE FRAUD

DIF’s Structure

148 sworn law enforcement positions 112 detectives

Supported by 41 non-sworn positions Crime Intelligence Analysts Administrative Secretaries and other professional support occupations

Organization Office of Professional Standards and

Planning Fraud Operations Bureau of Workers’ Compensation Fraud Bureau of Criminal Intelligence & Analytical

Support

Personnel allocation Five regions 11 statewide field offices 23 squads

Filing Complaints

http://www.myfloridacfo.com/fraud/

Initial submission should be done through web site

No need for sending supporting documentation until requested

Nothing prevents you from contacting DIF to review referral either before or after submission

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Filing Complaints http://www.myfloridacfo.com/fraud/

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What to Expect

Acknowledgement letter

Tip routing

Supervisory review

Case assignment

Investigative process

Filing decision

Prosecution

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Types of Arrests FY 7/01/13 TO 3/31/14 Total of 1,111

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PIP Fraud WC Fraud Fraud - All

Other

Licensee

Fraud

Vehicle

Fraud

Homeowners

Fraud

Application

Fraud

423 367 141 53 46 33 48

PIP Fraud, 423, 38%

WC Fraud, 367, 33%

Fraud - All Other, 141, 13%

Licensee Fraud, 53, 5%

Vehicle Fraud, 46, 4%

Homeowners Fraud, 33, 3%

Application Fraud, 48, 4%

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Common Scams during disaster

1. Auto/Vessel2. Property3. Business

•Unscrupulous Public Adjuster/Contractor Scams•Unlicensed activity•Theft of payments•Use of inferior materials•Poor quality work•Caused/increased damage•Billing for services not rendered•Double billing•Organized scams

• At times with assistance/knowledge of property owner who realizes damage is not fully covered

DIF Responses

Joint operations – public awareness Agent and Agency

Workers’ Compensation Compliance

Local authorities/licensing

ESF 16 Responses

Insurance Villages

Fraud investigations

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Public Adjusters Recruiting Scheme

Public adjuster hires “runners” familiar with the area.

“Runner” solicits homeowners with little or no damage to file claims.

Entice homeowners with promises of large insurance settlements if they increase the damage to their homes.

Inflated claim brings higher fees for PA.FSS 626.854 PA Defined; Prohibitions

FSS627.707 Policyholder may not accept rebate

State issued orders to protect consumers

Emergency rules relating to Public Adjusters.

Consumer protection rules issued by the CFO / OIR.

Limits PA fees to 10% of the claim (20% otherwise not related to State of Emergency)

Prohibits PA’s from collecting up-front fees.

Establishes a 14-day contract rescission period.

Prohibits PA from entering into a contract on a residential total loss.

Public Adjusters Historically

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Andrew 1992 – 91

Opal 1995 – 170

Charley, Frances, Ivan and Jeanne 2004 – 1,180

Peaked in 2008 – 2,515 Resident

and 407 non- resident PA’s

Where we are today……

As of April 8, 2014:

Individuals currently holding Public Adjuster

licenses in Florida total 1,606 (vs. 2,515 in

2008)

1,219 of which have active appointments

There are 321 non-resident Public Adjuster in addition to the above, of which 206 hold active appointments

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Initiatives Focus on “Facilitators”

Partnerships

Technology

Re-alignment of resources

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Florida Property and Casualty Insurance Fraud Task Force

•275 plus members•Quarterly meetings at Lake Mary•Open to all

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Department of Financial Services

DIVISION OF INSURANCE FRAUD