A Provider Fraud Case Study: From SIU to DA– Part I

In this course, the attendees will be provided a live case study of a complex provider fraud scheme. The first hour will focus on the investigation from the SIU perspective; how was the fraud identified, how did the SIU investigators build their case, and what investigative tools did they use to uncover and unravel the fraud. After a break, two investigators from the San Bernardino DA’s office will discuss the same case, with a focus on how they started their investigation after receiving the FD-1, and the tools they used to uncover the fraud and determine the viability of a prosecution. Both teams of investigators will discuss investigative techniques and findings, in an effort to show the work that goes into unraveling complex provider schemes. Overall, the point of this course is to show both sides of an investigation – hopefully it provides understanding to law enforcement as to how SIUs identify and investigate cases. Likewise, it should provide understanding to insurance personnel of the how much work law enforcement still has to do even on a great case.