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The Big 2015 Fraud Fighting Conference Hits Big At Pala Casino
By Lonce LaMon - May 16, 2015

The Employers’ Fraud Task Force, under the leadership of Director Laura Clifford, put on The Big 2015 Fraud Fighting Conference at the Pala Resort and Casino on Pala Temecula Road in Riverside County just this past Thursday and Friday, May 14th and 15th 2015.

Luminaries from the claims industry, government, and the services sector were in attendance.

Cora Lee from the DWC Audit Unit gave a presentation during which she stated that late payments of workers’ compensation awards substantially hurt audit results for claims departments.  This applies to any type of award and any portion of an award, including liens that are sitting around with no attempts to settle them.

Laureen Pedroza, the Bureau Chief of the Fraud Division of the California Department of Insurance, was a member of a panel with Ed Miller, the Assistant Head Deputy of the Healthcare Fraud Division of the Los Angeles District Attorney’s office, along with the Head Deputy of that same department, Jennifer Snyder. Laureen brought up premium fraud and Jennifer explained to the audience how a material lie is a strong component of committing fraud which is different from an omission.

John Floyd, the senior and founding partner of Floyd, Skeren & Kelly, told his audience, “never use the term ‘hold harmless’”.   John and his firm were the benefactors of the luncheon for both days of the conference, while John was a member of a panel that talked about who defense attorneys truly represent.  It was partially entitled, “Do you know who your client is?” 


John Floyd, founding and senior partner of Floyd, Skeren & Kelly, together with his firm were the benefactors of the luncheon for both days of The Big 2015 Fraud Fighting Conference at the Pala Resort. 

Dave Jones, the California Insurance Commissioner, was the Keynote speaker for Thursday’s lunch.  He discussed a few salient fraud cases from recent history, which included the Kareem Ahmed and Landmark Medical Management case in Orange County which is presently under review by the Court of Appeal, Fourth Appellate District, Division Three.  This case involves 200 million dollars in workers’ compensation claims fraud pertaining to 25 million dollars in kick-backs to physicians along with a 175 million remainder amount caused by inappropriately prescribed, costly compounded medications. 


Laura Clifford, on behalf of the Employers' Fraud Task Force, thanks Dave Jones, the California Insurance Commissioner and keynote speaker for Thursday, May 14th, for his dedication to the fight against insurance fraud. 

An extraordinary presentation was given by Timothy Fives, a Special Agent from the California Department of Justice, together with Robert Hammond, an investigator with UNUM Special Investigation Unit.  Timothy Fives talked about why populations of ethnic groups come together as bands of fraud criminals and what in their histories causes this to occur.  This was a fascinating revelation.


Robert Hammond, center, won the raffle for tickets to the Dodgers' game from Frasco Investigations! The Dodgers are hot and are presently in first place in the National League West.  

The closing keynote speaker for lunch on Friday was Don Marshall, a fraud executive of Zenith Insurance Company and the chairman of the Fraud Assessment Commission.   He emphasized in his talk that claimant fraud makes up a small portion of the quantity of fraud in workers’ compensation and that it’s medical fraud that’s chewing up the system.


Don Marshall, Chair of the Fraud Assessment Commission, talked about perception as he held up a 1960 front page tax return form and pointed to the deduction line for children and dependents.  By 1987, Don said, when social security numbers became a requirement for dependents, seven million of them disappeared.  

Over the next several days, articles will be written in depth and published on adjustercom about what some of the individual speakers stated in detail in their presentations at this extraordinary conference called The Big 2015 Fraud Fighting Conference.


Laura Clifford, Director of the Employers' Fraud Task Force, was a gracious emcee throughout the two-day conference.  

Stay tuned…. 

 

lonce@adjustercom.com, Lonce LaMon, journalist; copyright adjustercom and Lonce LaMon, all rights reserved

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