Publications

Of those tracked anti-fraud bills, 78% are related to the Coalition's 2024 Legislative Priorities. Of those enacted, insurer use of consumer data privacy, artificial intelligence, and towing fraud topped the list. Consumer data privacy laws were added in Kentucky (HB 15), New Hampshire (SB 255), and New Jersey (SB 332). Each of them contain wording that the new laws will not restrict the prevention, detection, protection against, or response to identity theft, fraud, malicious or deceptive activities or any illegal activity, while preserving the investigation, reporting or prosecution of those responsible for any such action. New enacted towing fraud laws include three in Virginia (HB 1073, SB 66, and SB 94) dealing with non-consent tows and the prohibition of solicitation by wreckers. In Florida, HB 179 requires certain municipalities and counties to establish maximum towing rates. A few other highlights with enacted bills, thus far, include Utah SB 149 that creates the Artificial Intelligence Policy Act, two bills in New York focused on insurer accountability (AB 2078 and SB 8004), and Oregon established the crime of fraudulent misrepresentation by employers to reduce workers compensation premium (SB 1580). Coalition members can keep track of these tracked and enacted anti-fraud bills online via the Coalition's Interactive Map.

The focus on litigation financing maintains momentum. The Coalition has tracked 10 bills this year related to greater transparency in and regulation of litigation financing. This comes amid news reports of Russian investment firms' involvement in global lawsuits, possibly evading US sanctions. In New York, the unregulated litigation lending industry is under scrutiny for promoting frivolous lawsuits and hiking insurance costs, particularly in construction. In a New York Post article, the Associated Builders and Contractors (ABC-NYS) and Real Estate Board of New York (REBNY) have joined forces with others to combat the litigation lending industry, which they and other critics say is rife with fraud and abuse. An ABC-NYS spokesperson said, “We’ve created a market of fraudulent claims where an allegedly injured worker is laying down on the job, walking off the job, calling 911 and by the time they get to the hospital, they’ve already been met by their attorney.” New York SB 2594 seeks to add state regulation to litigating financing while SB 8413 and AB 8981 both seek to criminalize the staging of accidents at New York construction sites. Stay tuned as this progresses. 

Legislators will gather in Nashville at the NCOIL 2024 Spring Meeting. The National Council of Insurance Legislators (NCOIL) was established in 1969 to play a pivotal role in shaping insurance policy across states, preserving state jurisdiction over insurance as mandated by the McCarran-Ferguson Act, and educating policymakers on insurance issues. This year's Spring Meeting will feature discussions on agenda items crucial to the Coalition's 2024 Legislative Priorities, including a dialogue between NCOIL and the NAIC that will provide updates on the adoption of the NAIC’s Model Bulletin on the Use of Artificial Intelligence Systems by Insurers, introduction and discussion of the NCOIL Transparency in Third Party Litigation Financing Model Act, among many other important issues. The Coalition's Director of Government Relations, Brent Walker, will attend the Spring Meeting and provide updates at a later date. Prior to the Spring Meeting, an Interim meeting was held where the NCOIL Public Adjuster Professional Standards Reform Model Act was passed and will be presented for ratification in Nashville.

Healthcare data breaches soared to record-breaking levels in 2023, fueled by a surge in ransomware attacks and increased targeting of the third-party vendors hospitals and other healthcare providers use. Exposure of protected health information and personally identifiable information can put patients at risk of identity theft or insurance fraud. “Be careful not to share sensitive information over e-mail, text messages or other communication paths that might not be so secure,” said Errol Weiss, chief security officer at the Health Information Sharing and Analysis Center. Here are steps you can take if your personal health data has been exposed, according to guidance by the Federal Trade Commission. How do you know if your data has been breached? Federal law requires healthcare organizations to report to Health and Human Services any security breaches that expose patient information. Search by company name, breach type or company location to see if your health information has been compromised. Don’t see a searchable database? Click here. 

Addressing insurance fraud in New Orleans: impact and industry response. Insurance fraud remains a significant concern in New Orleans, reflecting a broader challenge faced by the insurance sector nationwide. Recent trends have highlighted an uptick in fraudulent activities ranging from exaggerated claims to elaborate schemes designed to defraud insurers. The implications of such actions extend across the industry, influencing policy costs and the overall trust in insurance mechanisms. The insurance industry has been proactive in addressing these challenges. Initiatives include the deployment of advanced data analytics and the integration of artificial intelligence in the claims evaluation process. These technological solutions enhance the ability of insurers to scrutinize claims more effectively, identifying inconsistencies that may indicate fraudulent activity. Additionally, the industry emphasizes the importance of collaboration with law enforcement and regulatory bodies to streamline the investigation and prosecution of fraud cases. Education plays a pivotal role in the fight against insurance fraud. By informing policyholders about the consequences of fraud and how to report suspicious activities, the industry aims to foster a culture of integrity and vigilance. These efforts are crucial in maintaining the trust that is foundational to the insurance process.

Streamlining E-Insurance: Protecting consumers against digital fraud. The introduction of mandatory e-insurance by the Insurance Regulatory and Development Authority of India (IRDAI) marks a significant milestone towards improving the insurance sector and streamlining processes for consumers in the country. E-insurance, the digital transformation of traditional insurance processes, will revolutionize the industry by digitizing policy documentation and streamlining customer interactions. But this paradigm shift raises a crucial concern: How can consumers be safeguarded from the escalating threat of digital fraud? After all, insurance fraud impacts everyone across the world, not just in the United States or Europe. One of the major benefits is that advanced fraud rings may involve multiple people submitting fake claims. Network analysis tools can identify connections between seemingly unrelated claims, revealing patterns that suggest fraud. While the advent of e-insurance heralds a new era of convenience and efficiency, it also necessitates vigilant measures to combat digital fraud. By harnessing the power of technology and implementing stringent security protocols, insurers can safeguard consumer interests and uphold the integrity of the insurance industry. Ultimately, a collaborative effort between regulators, insurers, and consumers is imperative to fortify defenses against the burgeoning threat of digital fraud in the realm of e-insurance.

Texas headquartered law firm McClenny, Moseley & Associates (MMA), which has faced fraud allegations and multi-million-dollar fines over “tech-enabled” hurricane lawsuits, has filed for bankruptcy. The law firm shot to infamy in the Louisiana insurance community last year, when it transpired the business had signed up potentially thousands of policyholders for hurricane-related home insurance claims, in many cases without their knowledge. The LDI slapped MMA with fines totaling $2 Million in February 2023. Former Louisiana Commissioner of Insurance Jim Donelon described MMA’s actions as an “illegal scheme” and “like nothing I’ve ever seen before.” The firm had filed 1,500 hurricane lawsuits in just three months as it looked to mass settlement tactics. Many insureds were not aware that the firm claimed to represent them. Outside of its regulatory wranglings, MMA has found itself dogged by legal actions, including a class action spearheaded by Monson’s wife, Katherine Monson. The business has sought to appeal a $10 Million default judgment in a case brought by PCG Claims.

Connecticut man indicted for earning nearly $1 Million through his fraudulent prize insurance company. Kevin Kolenda, of Norwalk, has been charged with six counts of wire fraud. The allegations against him: Records show that Kolenda owns and operates a company called Hole In Won, which provides insurance to people or groups offering prizes at events like golf tournaments and fishing contests. Victims of the scheme would sign an insurance contract and pay an insurance premium before hosting a contest, like a golf tournament that promises a new car to a player who hits a hole-in-one. Through the contract, Kolenda and Hole in Won would promise to pay out the insurance claim for the cost of the insured prize if there was a winner at the event. If no one won the insured prize, Kolenda and the company would keep the premium. Kolenda defrauded people and organizations out of nearly $1 Million, including about $850,000 in insurance premiums paid under false pretenses and more than $100,000 in prize costs that the company has failed to pay. Kolenda used different fraud techniques to avoid paying claims, including making excuses to victims as to why they didn’t have to pay, referring them to a made-up “claims department” in Washington D.C., and threatening them with “bogus legal action and reputational harm” if they continued to ask for their money. 

Fort Smith couple found guilty of lawyer scams. Sebastian County District Court Judge Amy Grimes delivered a guilty verdict against Leigh Ann Saffer and David Saffer for the unauthorized practice of law. The Saffers solicited business for car accident victims on behalf of chiropractors under false pretenses. The Saffers own Accident Claim Specialists in Fort Smith. The couple used local police reports to find car accident victims as potential clients. They then contacted the victims and presented themselves as legal experts capable of interpreting legal documents and negotiating with insurance companies. Victims were directed to a chiropractor in exchange for a referral fee. Several victims testified in trial that they were repeatedly solicited by the Saffers to go to Arkansas Chiropractic Group. "These chiropractic runners are being paid by chiropractors to solicit cases from vulnerable people, people who have just been in a car crash. Oftentimes, they'll show up at their house. They'll call them, text them. And they're relentless," Fort Smith attorney, Joey McCutchen said.

Garden City man cheated insurance companies out of $235,000. Vassilios Handakas, also known as William Handakas and Bill Handakas has been charged with insurance fraud for allegedly underreporting payroll to insurance companies. Prosecutors say: Vector Structural Corporation and Handakas entered into a contract for a workers’ compensation policy with an insurance company for coverage between March 2019 and March 2020. In the application, the company indicated that it employed two masons with an annual payroll of $50,000 a year. Records the company and Handakas filed with the state, however, indicated that Vector had 13 employees during that time frame and a payroll of $625,000. The underreporting of the employees and payroll resulted in an underpayment of insurance premiums of $197,000. In March 2020, Handakas and Vector repeated the underreporting of workers and payroll on its policy application with another insurance provider. The company claimed it had a payroll of $20,000, when the actual payroll according to state records was $106,000. Handakas is due back in court on April 10. If convicted of the top charge, he faces a potential maximum of 5 to 15 years in prison.

Benicia contractor pleads guilty to insurance fraud after underreporting nearly $1 Million in payroll. Kent Bo Fridolfsson, of Benicia, pleaded guilty to six charges of insurance fraud and grand theft after an investigation. Fridolfsson underreported payroll by nearly $1 Million to illegally save on workers’ compensation insurance and taxes. Fridolfsson was the former president and owner of the construction company Diversified Specialists and had been a licensed contractor in California since 1986. Fridolfsson had insurance coverage with the State Fund from 2010 to 2021 and was required to report payroll during each policy period. From 2010 to 2019 Fridolfsson reported zero payroll to State Fund; however, in January 2019 one of his employees contacted State Fund after sustaining a work-related injury. After being contacted by the State Fund, the Contractors State License Board conducted a site inspection of Fridolfsson’s business and interviewed a number of his employees. Fridolfsson was placed on formal probation, ordered to pay over $725,000 in restitution, and ordered to surrender his contractor’s license.
 

With a steadfast commitment to integrity and accuracy, Rockholt and Associates scrutinizes vast volumes of medical claims data, detecting irregular patterns indicative of fraudulent billing practices. Through comprehensive audits, Rockholt and Associates meticulously cross-reference billing records with patient histories and medical procedures, uncovering discrepancies showing fraudulent intent or misrepresentation.

Evolving beyond traditional medical bill review and auditing, Rockholt and Associates is committed to making a tangible difference in combating medical billing fraud. They provide a comprehensive analysis, personalized support, recognizing each case is unique, and tailoring our reports and evaluations to what each client’s needs.

Rockholt and Associates' commitment to upholding the integrity of the healthcare industry through innovative strategies is commendable. Mike, Tami, and their team's dedication to enhancing their reports and evaluations underscores their relentless pursuit of excellence. Their receptiveness to feedback demonstrates a proactive approach to delivering top-notch work.

Tami's journey into bill review following a ski accident highlights her resilience and adaptability in the face of challenges. Her extensive experience as an expert witness for over two decades attests to her expertise and credibility in the field. Overall, Rockholt and Associates' blend of innovation, dedication, and expertise positions them as leaders in the healthcare industry. 

We are deeply saddened by this loss and wanted to extend our sincerest condolences to Tami Rockholt and her family during this difficult time. Mike's contributions to our coalition and the healthcare community as a whole were truly invaluable. His dedication, expertise, and unwavering commitment to excellence have left an indelible mark on all who had the privilege of working alongside him. His passing is not just a loss for us professionally, but for all those whose lives he touched with his kindness and compassion. Our thoughts and prayers are with Tami and her family as they navigate through this time of grief and sorrow. May they find solace in the cherished memories they shared with Mike, and may his legacy continue to inspire and uplift us all.

In just 4 ½ months the International Association of Special Investigation Units (IASIU) will be hosting our Annual Conference at the Opryland Resort in Nashville, Tennessee! This will not only be a fantastic conference bringing SIU leadership & investigators, regulators, law enforcement, defense counsel and so many more together to learn, grow, and connect. It will also be a celebration of IASIU’s milestone 40th Anniversary! I encourage our strategic business partners that are in the business of providing the tools and services in support of the fraud fighting community, to join us for this premier event. By participating, you'll have the chance to connect with decision-makers and professionals eager to learn about the latest advancements and solutions in combating fraud. There still are some exhibit booths and sponsor opportunities available for this year's conference, so act fast before they are all gone. This is your chance to elevate your brand visibility, generate leads, and forge valuable connections with key stakeholders in the industry. To learn more about our sponsorship packages or to reserve your exhibit space, please reach out to us at [email protected]. Additionally, visit our conference site to discover what our past sponsors have said about their experiences and the benefits of partnering with IASIU. Don't miss this opportunity to showcase your brand and contribute to the success of our members as well as celebrate our 40th year Anniversary. Secure your spot today and position your company as a leader in fraud prevention. We look forward to your partnership & welcoming you to Nashville!