Fraudsters are responding to success stories in the media about companies catching them in the act by changing tactics and learning how to hide their footprints.
ExamWorks Investigation Services head of profiling and research, Mike Hodge, says his team observes frequent signs that organised fraudsters are spotting the flaws in their approach and ‘changing up’ to ensure investigators remain one step behind.
“The good publicity the insurance industry has generated over the past few years is beginning to resonate with the fraud ‘community’,” says Mike. “It’s a fairly constant battle and fraudsters are changing up. For example, they have come to realise that social media profiles are a significant vulnerability and we are increasingly seeing profiles locked down and the use of encrypted messaging services like SnapChat and Whatsapp to provide more secure means of communicating a criminal enterprise.”
Mike says deep dive investigation has gone beyond ‘thinking outside the box’. “In many ways, we’ve had to get rid of the box and move to the next level. Investigators promising that you can simply trawl Facebook or Twitter are not being honest with their customers.
“Our product hasn’t fundamentally changed, but it’s incumbent upon us to adapt our investigation techniques and data sources as the dynamics of fraud change around us. The challenge for us all is that while the industry must continue with its deterrent message that fraudsters are being caught; this has the unintended consequence of helping determined criminals to adapt their own techniques.
“I am seeing more locked down profiles after the event or no mention of an event on the profile where there is some suspicion. The latter is of course suspicious given that most of us would openly discuss something as dramatic as an accident with our friends online if we had nothing to hide.”
Mike adds that he has also seen quite a few pieces of rather obvious social engineering; “an individual with a minor injury will engineer the account to make it look like the injury is much more serious than it is by posting pictures of struggling with crutches, bandages or referring to physical activities which cannot be done thanks to the alleged accident.”
BEYOND SLIP AND TRIP
EWIS is currently handling a large number of personal injury investigations and Mike says class action investigations are now on the agenda. “These are typically employers’ liability claims in which 20-30 individuals from the same company bring an action together.”
EWIS’ investigators are looking back into people’s histories to explore all avenues and build a picture of the subject within a compliant environment. “It’s a necessary part of reviewing claims like this,” says Mike. “We have to ensure their symptoms match what is being stated in the claim.”
Mike adds that the threat to clients has moved beyond purely fraud for financial gain, with a distinctly malicious tone emerging. “We have had instructions relating to direct attacks being made by former employees designed to damage the brands of companies. We cannot give details, suffice to say that groups of disgruntled individuals have allegedly approached clients of their former employer, deliberately with the intent of damaging those relationships. It includes malicious phone calls but also a number of other tactics that we can’t disclose.”
EWIS frequently observes evidence of collusion in such cases and has always been able to provide court-ready documentation. “In unique circumstances, we will often see such investigations move towards the criminal courts, which is understandable.”
If you would like more information about how claimant profiling and research can help your business, please contact Ann Lomax, Senior Client Relationship Manager, ExamWorks Investigation Services firstname.lastname@example.org