Anti-Fraud Director Speaks at Dairy Industry Meeting
December 2, 2009
Larry LaPointe, director of the New York State Insurance Fund Division of Confidential Investigations (DCI), will speak at the executive committee meeting of the Northeast Dairy Association Safety Group, representing five dozen of the region’s major dairy companies, about workers’ compensation fraud on December 3.
Mr. LaPointe heads one of the state’s most successful special investigation units fighting insurance fraud. In 2008, NYSIF DCI investigations of workers’ compensation and disability benefits insurance fraud against NYSIF led to 148 arrests and $20.7 million in restitution and estimated potential savings.
In over a decade fighting workers’ compensation fraud, Mr. LaPointe and DCI have accounted for more than 1,300 arrests and over $166.5 million in restitution and future savings. NYSIF is the state’s largest carrier of workers’ compensation and disability benefits insurance.
“We provide our policyholders fraud protection in ways that no other carrier in New York can match,” Mr. LaPointe, a former prosecutor who previously directed the New York State Insurance Department Frauds Bureau, said.
The Northeast Dairy Association Safety Group, one of three safety groups in NYSIF managed by Keevily Spero Whitelaw, Inc., started with NYSIF in 1949. Comprised of 60 New York dairy manufacturers, processors and distributors, its members are some of the more recognizable dairy businesses in New York State, including Tuscan, Farmland, Elmhurst, Byrne, Queensboro Farms, Dairy Barn stores, Stewart’s and Upstate Farms.
It is part of a larger trade group started in 1928 and based in Syracuse, NY, the Northeast Dairy Foods Association, Inc. (NEDFA), comprised of 111 members including international businesses as well as small and family-owned companies.
“Ensuring conformity to workers’ compensation laws and regulations is important to our group,” NEDFA Executive Vice President Bruce Krupke said. “Fraud is not a regular occurrence, but it can happen and we recognize the need to practice fraud prevention among our members. We appreciate the state’s effort in fighting fraud.”
Mr. Krupke said the trade group discusses fraud prevention with its members every year, but this is the first year they have asked NYSIF’s anti-fraud director to speak at their annual meeting.
Mr. LaPointe’s talk will provide an overview of NYSIF’s anti-fraud program and address some of the more common fraud fact patterns, or “red flags,” that lead to DCI cases. These include sketchy claims details or discrepancies in accident/injury reports, a claimant’s behavior or employment history, and the timing of a claim.
“Generally, if you find clusters of ‘red flags’ connected with a claim, the claim should be examined to determine if the claimant has lied about any material fact,” Mr. LaPointe said.
DCI annually reviews fraud detection strategies with investigators and continually trains all NYSIF Claims personnel to spot red flags. It also provides training for NYSIF staff in other fraud detection methods, Mr. LaPointe noted.
In addition to claimant fraud, NYSIF aggressively investigates policy fraud, which can take on several variations including premium fraud by a policyholder to conceal payroll, the nature of a business, or number of employees, Mr. LaPointe said.
The meeting takes place at the New York Athletic Club in New York City at 3:00 pm.