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Zalma's insurance fraud letter – April 1, 2019



* All areas increased from 2016 to 2018. Almost 60 percent of non-PC insurance companies use money laundering technology. Only 20 percent of computer insurance companies use technology to reveal such systems.

* The use of technology to detect cyber fraud has doubled in two years, probably due to regulatory requirements recently adopted to put such systems in place.

* Large insurers and non-PC companies are least likely to integrate business rules and red flags into their anti-fraud systems.

* No non-PC insurers reported using text memory in their technology mix.

* 27 percent of insurance companies said their System is built and hosted by external suppliers.

* Property insurance companies are most likely to use third-party data (80 percent).

* Small insurers usually use social media, public records and unstructured data.

* Only 1

0 percent of non-PC insurance companies use unstructured data in their systems.

* Half of non-PC companies reported receiving less than 10 percent of referrals from their technical systems. 59002] * 29 percent of large companies received 30 percent or more of referrals from their systems, while only 13 percent of small businesses did. Large insurance companies were least likely to build and maintain their home systems.

* 40 percent of non-PC insurers quoted "improved reporting" as an advantage over only 13 percent of PC companies.

* Only 10 percent of non-PC insurers quoted "reveal complex or organized fraud prevention" as compared to 35 percent of PC companies.

* Non-PC insurance companies seem to have much less problems with lack of IT resources than PC carriers (50 percent vs. 83 percent)

* Non-PC insurance companies, however, often mention a false positive and fake negative than PC insurance companies (80 percent compared to 53 percent).

* Small insurance companies were much more likely to say that their SIU could not adhere to tech-generated references than larger carriers (50 percent versus 25 percent).

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Curved insurance agent stops in prison

It's not Nice to see ll false politics and sabotage with witnesses

Patricia Sledge created false AFLAC policies and claims and received as an agent for AFLAC in excess of $ 4 million. She was caught, tried before a jury, sentenced and sentenced.

In United States v. Patricia Diane Smith Sledge No. 17-50363, United States Appeal Court for the Ninth Circuit March 11, 2019) Sledge appealed from her jury's conviction and sentence for mail fraud, contrary to 18 USC § 1341 and witnessing manipulation, in violation of 18 USC § 1512 b (3). Sledge, a sales association for the American Family Life Assurance Company (AFLAC), orchestrated a comprehensive insurance fraud control system.

FINDINGS

There was sufficient evidence to support Thus two witnesses manipulated beliefs. The Constitution prohibits, among other things, "corruptly persuading" a witness to lie to investigators. This language includes non-compulsory attempts to convince the witnesses to lie to investigators. Seeing the evidence in the light that is most favorable to the prosecution, a rational fact factor could have found that Sledge was trying to corruptly convince the two witnesses to lie to investigators.

The District Court did not exercise its discretionary scope by allowing Exhibition 1, a spreadsheet summarizing the insurance policies and claims generated by Sledge as AFLAC identified as fraudulent. AFLAC analyst Susan Gonzales testified that she created the worksheet, which drew data from an AFLAC database of policy and liability information, at the request of an AFLAC investigator as part of the company's internal investigation. Contrary to Sledge's truth, Gonzalez had personal knowledge of the worksheet as his creator. Gonzalez's lack of personal knowledge of whether the summary policy and claims were actually fraudulent affects the importance of Exhibition 1, not its admissibility.

Furthermore, the inclusion of exhibition 1 did not violate Sledge & # 39; s Confrontation Clause rights because the worksheet was not based on any hearsay from the AFLAC investigator. Gonzales just mentioned the investigator to explain why she was preparing the worksheet (that is, its effect on the listener), not for the truth of any statement from the investigator.
The prosecutor did not commit in maladministration by referring to exhibition 1 argument. Posten shows that the prosecutor correctly describes Exhibit 1 which summarized the policies and claims that AFLAC had identified as fraudulent. In addition to the AFLAC identification, there was also independent evidence in the record supporting the fact that the policy and requirements of List 1 were actually fraudulent.

Finally, during the court proceedings, the district court did not find that the amount of loss attributable to such fraudulent systems was over $ 4.1 million, resulting in an improvement of 18 levels below. Likewise, the Court did not make a clear mistake in demanding repayment of over $ 4.1 million under the 1996 Mandatory Offerings Act.

ZIFL OPINION

Sledge defined by its actions violations of the Covenant of Good Faith and fair trade, by cheating their employer, AFLAC, as agent and applicant. Her prison sentence and repayment order should give her a lot of thought when she sits in her room at the gray-child hotel.


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