Forensic accounting and insurance fraud investigations

TDI’s Fraud Unit has investigators, prosecutors, fraud examiners, attorneys, and support staff. Vivian Cervantez’s job is performing financial analysis and forensic accounting services. As a financial analyst, her efforts help investigate cases of insurance fraud. What kind of work does a fraud analyst do?  We’re examining a lot of data and looking for unusual patterns. A fraud analyst’s work can include converting bank statements into Excel spreadsheets and providing summary tables for investigators. Other times, work involves cross referencing bank statements, billing records from doctors, and claims data from insurance companies.   What is forensic accounting?  Forensic accounting is the marriage of accounting and investigating. Accounting involves records and the recording of transactions. Forensic accounting is taking those records and using them to find out if there is a misuse of funds or if there are any patterns of misuse.  What’s an example of forensic accounting?  A policyholder, like a homeowner, might pay their policy premium to an insurance agent. The agent then keeps the money instead of handing it over to the insurance company to pay for the policy. A financial analyst’s research may see the money going into the agent’s accounts but doesn’t see it paid out to the insurance company. That’s insurance fraud.  Why is financial analysis important?  Insurance fraud leads to higher insurance premiums for everyone. The Fraud Unit’s efforts to cut down on the amount of insurance fraud should help keep insurance more affordable by reducing the impact that fraud has on insurance premiums.  How do you avoid becoming a victim of insurance fraud?  In the case of giving your money to a bad agent who doesn’t give you a real policy in return, do your research. You can call our Help Line at 800-252-3439 to make sure an insurance agent is licensed. Try to pay the insurance company directly. Don't pay the agent in cash. Use debit or credit. If something feels wrong, then it probably is wrong.   Report insurance fraud Insurance fraud guide Fraud investigator helps shut down COVID-19 testing fraud How TDI helped bring down fraudster "Doc" Gallagher