IMO/Broker Fraud

Message Author
ampm-bookmark
delicious-small Add to delicious
yahoomyweb-small Add to YahooMyWeb
blinklist-small Add to BlinkList
PostPosted: Sat May 03, 2014 6:21 pm   Post subject:   

Hypothetically speaking, you would have to have indisputable proof of fraudulent billing. Assuming I had that, I would approach the broker/IMO with my evidence and simply ask questions. Play dumb if you want.



"Mr. Broker, I'm not sure I understand this: Right here, we can clearly see you've billed Blue Cross for marketing that never happened. Why would a successful guy like you bill insurance carriers for work that was never performed? I wonder how the insurance companies would feel about this? I wonder if this is illegal/unethical/immoral? What should I do here?"



Some people are going to call this type of approach confrontational. Good God, we'd hate to hurt anyone's feelings - especially if they're ripping off insurance companies.



The chances of you finding a regulatory agency that'll take an interest in this sort of thing are slim at the very best. You might call he insurance company and see who'll chat with you about it.



It certainly seems as though your intentions are good and I applaud that. Good luck.



_________________

Please feel free to go to my website at www.markcolbert.com or, if you have a specific question, you can email me directly. I hope I can answer any questions you might have. If not, I can certainly find an answer right away.
InsInvestigator
Community Consultant
Leave a quick message

InsInvestigator

Joined: 13 Oct 2007
Posts: 625

Location: Central California
33.00 Dollars($)

PostPosted: Sat May 03, 2014 11:54 pm   Post subject:   

Thanks for the input INvestigator,I appreciate it. So hypothetically if i had what I believe to be copies of invoices provided to the broker, who then submitted them to the Ins Companies, its your opinion the CA DOI investigators wouldnt pursue this? The amount of invoicing is quite substantial, deep into the six figures. I assume one would contact the SIU reps at the Companies affected?


_________________
Register Now to have your Insurance queries solved.
Bart
Guest







PostPosted: Mon May 05, 2014 9:19 pm   Post subject:   

Again, hypothetically speaking:



I doubt CDOI's investigators would give you anything more than a letter explaining why they can't/won't help.



Quote:
I assume one would contact the SIU reps at the Companies affected?




I think that would be a great idea.


_________________

Please feel free to go to my website at www.markcolbert.com or, if you have a specific question, you can email me directly. I hope I can answer any questions you might have. If not, I can certainly find an answer right away.
InsInvestigator
Community Consultant
Leave a quick message

InsInvestigator

Joined: 13 Oct 2007
Posts: 625

Location: Central California
33.00 Dollars($)

PostPosted: Tue May 06, 2014 1:45 pm   Post subject:   

Hypothetically of course, if the indisputable documents were in hand and DOI had been contacted and commented that they wanted the whistleblower to come in and meet for an interview would you have any advice on how one would proceed with them? Would a Qui Tam suit be the logical course of action? Appreciate your comments Investigator.


_________________
Register Now to have your Insurance queries solved.
Bart
Guest







PostPosted: Tue May 06, 2014 2:26 pm   Post subject:   

If the DOI had been notified and asked the person holding the indisputable documents to come in for an interview, I think they should do exactly that. The False Claims Act would be a great option if there are substantial damages. Good idea. If you need a Qui Tam law firm, let me know.



_________________

Please feel free to go to my website at www.markcolbert.com or, if you have a specific question, you can email me directly. I hope I can answer any questions you might have. If not, I can certainly find an answer right away.
InsInvestigator
Community Consultant
Leave a quick message

InsInvestigator

Joined: 13 Oct 2007
Posts: 625

Location: Central California
33.00 Dollars($)

PostPosted: Tue May 06, 2014 3:31 pm   Post subject:   

Thanks again, can you provide the law firm info, seems it would be advisable to talk with them before the DOI or not?


_________________
Register Now to have your Insurance queries solved.
Bart
Guest







PostPosted: Tue May 06, 2014 5:12 pm   Post subject:   

I've been informed that I cannot refer law firms in this forum. Either send me an email, give me a call or Google Qui Tam and see what comes up.



_________________

Please feel free to go to my website at www.markcolbert.com or, if you have a specific question, you can email me directly. I hope I can answer any questions you might have. If not, I can certainly find an answer right away.
InsInvestigator
Community Consultant
Leave a quick message

InsInvestigator

Joined: 13 Oct 2007
Posts: 625

Location: Central California
33.00 Dollars($)

PostPosted: Tue May 06, 2014 5:38 pm   Post subject:   

Understood, will give you a call a bit later. Thanks


_________________
Register Now to have your Insurance queries solved.
bart
Guest







Quick Reply
Your Name
Subject
Message body
All times are GMT
Page 1 of 1


Get a Quote
Ask Community Experts

flash plugin

Quick Links

Must See

Community

Hot topics in forums

Latest in blogs

AmPmInsure on Facebook



Page loaded in 0.239 seconds.