Investigation insights: How to take hold of referral sources

Investigation insights: How to take hold of referral sources

Polonious_Investigation Insights Study Cover

During the International Association of Special Investigation Units (IASIU) conference held virtually on September 14 and 15, 2020, Polonious ran a panel discussion with some of the world’s leading investigation professionals. Investigation Insights contains new research into the performance, effectiveness and challenges of special investigation units, and communicates how better insights can drive improvements in productivity. You can download the full report here.

In this blog, we will review how referrals are garnered and why it is important to vet them properly.

When respondents were asked how cases were referred to them for investigation their responses were somewhat predictable. Most SIUs (85%) get referrals from claims units. Beyond that, other methods of sourcing referrals were reasonably evenly spread.

 

Figure 3: How cases are referred for investigation

 

Automated tools such as analytics engines using predictive analytics, machine learning, artificial intelligence and rules-based algorithms are employed by 50 per cent of organisations, 60 per cent use fraud hotlines, and 65 per cent said they seek out cases proactively.
It is important to note though, that we did not ask what proportion of cases are referred from each of these sources.

A big surprise for us was that around half (52.63%) of respondents did not record the number of false positive referrals they receive — those that, on first glance from an experienced investigator, are clearly not going to go anywhere — from either an analytics tool or their claims unit.

 

Figure 4: Keeping track of false positives

 

A smaller but still significant percentage (38.89%) told us that when they did receive a false positive they did not feed the information back to the analytics tool in order to improve referrals.

Triaging referrals

There will always be claims that legitimately warrant suspicion but, upon investigation, turn out to be valid. Where you want to draw the line on level of suspicion is a matter for each SIU. You may only want to investigate “slam dunks”, or those with a 100 per cent strike rate, but risk a lot of potential fraud slipping through. Or you may want to investigate every possible case, but end up spending a lot of time on claims that turn out to be valid.

This triage process might not take a long time — but even if it takes about five minutes per case, after 100 false positives, you have lost a whole day of work. In SIUs with high case volumes, this adds up. And in SIUs with low case volumes, there is likely not much budget to waste on spinning wheels.
At a minimum, reporting on raw numbers can identify some inefficiencies before putting pressure on investigators.

Compare this to the SIUs that did record false positives. About a sixth of those respondents had between 21 and 40 per cent of referrals as false positives, while a full quarter reported that between 41 and 60 per cent of their referrals turned out to be false positives.

 

Polonious SIU Metrics Report Figure5

Figure 5: What percentage of referrals are false positives

 

While this was just a quick questionnaire with a small sample size (only 12 respondents for this question), if the numbers are representative of the wider industry there is a big proportion of SIUs where around half their cases should not even have been referred to them for investigation. What’s more, around half of them would not even know a referral was a false positive.

As mentioned above, of the units that track false positives, almost 40 per cent are not feeding these back into the detection tool, so we would hope that these are not the units receiving 41 to 60 per cent false positives.

 

Figure 6: Proportion of organisations feeding results back into fraud detection tools

 

Analytics tools work by learning the flags for fraud — either through AI or through analysts updating the rules as they receive data. If false positives are not being fed back into these tools, they cannot update the rules, and they are going to keep sending you bad cases.

If you are getting 50 per cent false positives, you are paying investigators to read case details and not provide value. And if these results are not being used to enhance your detection systems, you are going to be doing that every quarter.

3 Tips for Financial Abuse Investigations

3 Tips for Financial Abuse Investigations

As per our previous blog:

Financial abuse is a form of domestic and family violence which occurs when an abuser uses money and resources as a means to gain power, and to control their partner or family member.

While according to the Parliament of Australia, Financial Abuse of the elderly:

Involves family members in either: preserving an inheritance by not spending money on an older person’s welfare needs; or bringing forward an inheritance by using an older person’s assets for their own benefit

Although navigating a financial abuse case can often be difficult, following this guide will ensure an effective and legally sound investigation.

This paper is designed to help you understand:

  • Key Documents relevant to financial abuse investigations
  • Step-by-Step Investigation Process
  • Cases Involving the Elderly

Here are 3 things to consider when conducting a financial abuse case.

Key Documents for Financial Abuse Investigations

Documents are critical during any investigative process. This section will highlight:

  1. Key documents to collect
  2. Document management tips

Key documents which be particularly relevant for your Financial Abuse case can be divided into the following categories:

  • Medical Records
  • Bank and Financial Records
  • Legal Records
  • Other Records

Medical Records

  • Medication list
  • Doctor notes
  • Psychiatric evaluations
  • Notes about individuals accompanying elder to appointments and their relationship
  • Health insurance ID
  • Disabilities Documentations

Bank and Financial Records

 

1. Bank Records

  • Opening Documents (Signatures and other account owners)
  • Deposit Items (Checks from additional accounts/assets, and Deposit Items income from Investments)
  • Withdrawal Items (Signatures, cashier’s checks, and notes Withdrawal Items about purpose)
  • Cancelled checks (Signatures, payees, memo details,  endorsements, bank of deposit, account number)
  • Transfer Details  (Origin and destination accounts and account numbers)

2. Tax Statements

  • Property tax statements
  • Tax Returns

3. Financial Accounts

  • Bank/credit union statements
  • Credit/debit card statements
  • Retirement Accounts (401K, TSP, IRA)
  • Investment Accounts (stocks, bonds, mutual funds)

4. Sources of Income/Assets

  • Government benefits (social security, veterans, assistance for needy families)
  • Child support income
  • Alimony income

5. Financial Obligations

  • Mortgage statement
  • Lease
  • Utility bills (electricity, water, gas)
  • Alimony payments
  • Child support payments
  • Aged care facilities

Legal Records

Family Documents

  • Marriage License
  • Divorce Papers
  • Power(s) of Attorney (personal/property)
  • Will
  • Mortgage or Real Estate Deeds of Trust
  • Vehicle Registration/Ownership papers
  • ID (Passport/green card/driver’s license)

Other Records

When addressing situations of suspected financial abuse, it is important not to jump to conclusions. Regardless of the signs and whether an intervention was undertaken, it is important to document the situation. This will establish the case history and will assist in justifying timely interventions.

Document Management

Document management is critical to any investigation. Once you have gathered the above documents, it is important you manage them properly.

Consider the following tips:

1. Keep all original documents, photographs and records in one place

Because these documents contain such important and personal information, we strongly recommend that you keep all original documents, photographs and records in a safe and secure place.

2. Make a copy of both sides

We also encourage you to make a copy of these documents. Make sure to copy both sides, as important information is often printed on the backs of these documents.

3. Document dates obtained

We also suggest you document the date you collect and obtain necessary documents. This will help you track your investigation process.

Conducting Investigations

Here are important steps to consider during an investigation:

1. Establish a clear timeline including dates POA(s) were signed, suspect involvement, capacity determination, dates hospitalized, etc.

2. Summarize bank records by monthly cash flows: List inflows by source, and outflows by type or use. 

3. Reconcile total inflows and outflows to the beginning and ending statement balances.

4. Compare patterns and deviations observed in bank records to timeline.

5. Write a brief narrative, including facts of the case, findings noted, references to pieces of evidence, and conclude with a summary of related charges.

Financial Abuse Cases Involving the Elderly

Australian Institute of Family Studies reports that Financial Abuse is the most common form of elderly abuse. Read our insights in Financial Abuse: What is it? to understand how Financial Abuse unfolds in the context of elderly abuse.

Based on our insights, we compiled a list of key considerations to make when handling Elderly Financial Abuse:

1. Understand the Relevant laws

Laws, terminology and processes around the power of attorney differ across states and territories. It is important to understand the effects of a Power of Attorney made under the relevant law.

2. Provide Adequate Support

With diminished mental, physical capacities, elderly clients are more likely to require assistance and support.

Resources include:

  • Language Interpreters
  • Sign Language Support
  • Support person (who is not the person suspected of abuse)

These resources may help with understanding documents, as well as mediation and emotional support, given that victims often fear retaliation.

3. Consent of Client

Even if the client has some impaired capacity, it is important to include them in addressing the situation and to get their consent if and when practical. 

4. Offer legal options and law enforcement where necessary

Regardless of the assumption that older people do not wish to involve the police or the legal system, investigators are obliged to provide them with these options or provide a referral for accessing them.

Take a Client First Approach

It is important to plan for your client’s economic safety so that the risk of further economic abuse of your client is minimised.

Here are some suggestions to give clients: 

  • Change passwords, PINS and security questions for personal accounts on a safe computer
  • Change passwords, PINS and security questions for Centrelink, online shopping accounts, emails, mobile phones and social media accounts on a safe computer
  • Update your mailing address with any financial or other providers. Get a PO Box if your partner does not know your location
  • Request new bank cards for personal accounts if your partner knows your card details and cancel any secondary cards
  • Let mortgagors or lenders know about the separation
  • Gather important documents that show records of your financial position if it is safe to do so
  • For assistance with joint bank and credit card, utility bills and mortgage/ loans – talk to your family lawyer for some advice

 Further referrals:

Ways Forward

Financial, legal, and utility and telecommunications services are well positioned to detect financial abuse. Institutions should take appropriate measures if a client may be a subject of this abuse. 

Many institutions engaged in distributing public utilities such as electricity, gas, internet, as well as financial institutions have hardship/domestic violence support programs. Consider utilizing these resources to support your client.

The financial and legal system is difficult to navigate for a person with no expertise. It is critically important to understand the important documents and procedural protocols to ensure a fair and robust investigation, and ultimately protect your clients.

Obtaining the right documents and practicing proper document management  is critical for a financial abuse investigation. This includes: medical, legal and bank/financial and all other records.

Obtaining the right documents and practicing proper document management  is critical for any Financial Abuse Investigation. 

There are legal and ethical considerations to be made when handling financial abuse cases involving the elderly.

There are important legal and ethical considerations to make when handling cases of financial abuse of the elderly.

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Learn more about how Polonious can help you conduct Financial Abuse Investigations

12 Things to Include in an Investigation Report

12 Things to Include in an Investigation Report

Writing investigation reports is time consuming, and styles can vary widely between investigators. Having a template with fillable fields ensures a consistent style, as well as prompting investigators to ensure all the information is filled out. Having one on hand also means that you can fill it out over the course of the investigation, writing case notes and summaries into it as you go – saving time re-writing notes into your report at the end of the investigation. However the ultimate is, of course, a case management system such as Polonious, which can generate an investigation report for you at the click of a button.

 

Whichever way you are doing it, these are the fields that we find usually appear on an investigation report. We’ll use insurance fraud investigations as our main example, but these are applicable to other investigations too, such as banking fraud, complaints and workplace misconduct, education, and so on.

  1. Identifiers

    Case files should come with a unique case number for easy identification in whatever system you have – whether it’s physical files, spreadsheets, or a case management system, and these should be in a prominent position on the investigation report. This may be a claim or policy number, or a student or employee number. However this becomes complicated as you may have multiple investigations related to the same policy or person.

     

    We recommend assigning a unique identifier to each case, with other identifiers such as policy or claim number as secondary references in case you need to find information in another system.

  2. Investigator and Report Writer details

    Your investigator may be the person writing the investigation report, but this is not always the case. You should specify both for completeness and accuracy. For insurance cases, you may also wish to specify the claims handler.

     

  3. Referral source

    In an insurance case, this may be the claims handler, in which case you might not need an extra field. But it could also be another part of the business, or a tip line, or an analytics engine. For a misconduct or education case it may be a complainant or a witness.

     

  4. Key dates

    The three key dates you should include in the investigation report are the date referred, when you first received the case; the date entered or filed, which is when you first created the case file in your physical or electronic system – this may be different due to a delay in filing when you’re busy, and lastly; the date it was first allocated to an investigator. For a closed case, you may also wish to include the date closed.

     

  5. Case description/summary

    This should include the allegation or description of conduct or fraud being investigated. For example, in a misconduct investigation it will likely be an allegation from the complainant against the subject. However, for an insurance fraud case, it may be an event like a vehicle collision, and the reasons why it was flagged as possible fraud – e.g. over a certain value or within a certain window relative to policy inception or expiry. If the allegation was made by someone other than the victim, include whatever details you can about the victim.

     

  6. Special requests or instructions

    This is similar to, but separate from the above. In this section you outline what, specifically, you are looking into with regard to the allegation or event – where you started the investigation from and what you’re trying to prove. For example, ‘Check for consistency between body-shop quote and crash description in police report’ or ‘Determine whether X’s management decisions were applied consistently across the team or unfairly targeted the complainant’. This will give some context to the case history below.

     

  7. Subject details

    Enter any relevant details about the subject here. This will usually include name and contact details, as well as further information that may be relevant depending on the investigation type. For example, for an internal misconduct investigation you may include office location and staff number or job title. For auto fraud you may include licence number. For surveillance cases you should include a description of the subject – height, build, hair colour, etc. On certain case types, you may wish to include an ID photo.

     

  8. Case Notes/History

    List all of the actions taken on the case here, in chronological order. Include who was assigned and who completed the action, a brief description of the action, and the date, time, and location it was completed. For interviews and surveillance, include who was the subject of the interview or surveillance, as it may not always be the main subject of the investigation. Provide enough to outline a case history, but leave the detail for below.

     

  9. Photos/Surveillance Reports

    This section is more specific to auto or surveillance cases, but if you have photographs – e.g. of a crash scene or important photos from surveillance – you should include them here. They can also be included in the evidence log or brief of evidence below, but including key photos here makes the investigation report more compelling and easier to read than having to open another attachment. Additionally, you may wish to include the surveillance reports with the photos, as well as a summary of other surveillance.

     

  10. Interview reports

    Provide the detail here for any interviews you mentioned in #8 above. Provide the main details of each interview again, as well as:

    Any compliance requirements – length of interview, breaks taken, support people present (including translators). Anything required to show the interview was ‘by the book’. In Australia this now includes a number of requirements related to the General Insurance Code of Practice.
    Interviewer notes – summarise what was discussed during the interview, including the purpose of the interview (which should be relevant to point 5 above), the interviewer’s role, and any requirements about confidentiality or protection. The overview should include confirmation of the date, time, and location of any incidents discussed, and a description of the incident and description or identification of any other parties present – either involved or as witnesses. The notes should conclude with the interviewee’s review of the notes and agreement that they are a true and complete record of the interview, and this should be backed up with a signed statement or recording below.

     

  11. Evidence log/brief of evidence

    You should include a list of the evidence collected during the investigation. You should include the following details:

    Who collected the evidence, as well as their role in the investigation
    Date and time the evidence was collected
    Type of evidence – photo, video, forensic evidence, etc
    Where the evidence is stored (if applicable)

    Alternatively, you can attach a brief of evidence to the investigation report, listing all of the evidence details above and including any photographs, signed statements, surveillance and interview reports, and so on. If presented electronically, this can also include audio and video. For example, Polonious includes easy to create PDF briefs that include photos and documents, as well as secure links to video and audio files stored online.

     

  12. Recommendations

    Your last section should detail your findings from all of the above materials when considered alongside any relevant legal or policy frameworks such as insurance policy conditions, or employee codes of conduct. Should the claim be denied? Should disciplinary action be taken against the employee or student? Or does the evidence not support the questions the investigation was trying to answer? Support your recommendations by referring back to the details above – do not assume the reader will automatically make the same connections you did.

 

How can Polonious help?

 

If you have a case management system, you can log all of the above as you complete the investigation. Dates, subject details, case numbers, and so on all come across automatically.

Did you just write some notes in the case file? Well, when it comes time to create the report, we can pull those in to section #8 without you needing to summarise them again.

Logged some surveillance photos? We can show them directly in the investigation report and include their details – including metadata – in the evidence log. As mentioned above, they can also be included in a brief of evidence – even video and audio in electronic briefs – cutting hours or even days of preparation time down to an hour or two.

Additionally, as a process based system, all actions on the case which support your investigation report are maintained in the case history, with a full audit trail.

Investigation Reports - One click generation with Polonious

Polonious provides one-click investigation report generation.

Investigation Report - Include scene and surveillance photos easily

Polonious allows you to easily include scene or surveillance photos in your investigation report, alongside case notes and actions

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Investigation Insights: Download our new research report into the effectiveness of SIUs

Investigation Insights: Download our new research report into the effectiveness of SIUs

The team at Polonious is pleased to announce the release of our new research report, Investigation Insights.

Investigation Insights contains new research into the performance, effectiveness and challenges of special investigation units, and communicates how better insights can drive improvements in productivity.

During the International Association of Special Investigation Units (IASIU) conference held virtually on September 14 and 15, 2020, Polonious ran a panel discussion with some of the world’s leading investigation professionals.

Prior to the panel a short survey was conducted with 24 of the investigation professionals about approaches to performance management within SIUs, and the results were remarkable.

  • Almost a third of respondents do not have a system for measuring the effectiveness of the SIU, and about a third of those that do measure effectiveness are not allocating costs.
  • Around half of respondents do not record the number of false positive referrals regardless of source — whether they come from claims teams or from automated tools.
  • Limited tracking and reporting of false positives has a detrimental effect, because processes cannot be improved without this information.
  • Around 80 per cent of respondents measure performance of the SIU by the number of referrals. Number of referrals in isolation limits the ability for the SIU to improve customer service or identify opportunities for automation and must be seen in the context with other measures — especially considering the number of false positives and rejected claims.
  • A significant measure of the contribution an SIU makes to the organisation is ROI — costs versus savings on claims — but few respondents are tracking those reliably.
  • Many respondents are taking indirect measures such as training to improve SIU performance.
  • In terms of productivity, most organisations are using broad measures such as cycle time, but not looking at more granular indicators like time per stage.
  • Looking more closely at productivity can identify faults in the investigation process and improve overall performance of the SIU.
  • Less than half of respondents measure the quality of investigations, which means more than half are leaving themselves vulnerable if findings are disputed.
  • Less than half of respondents apply measurements of productivity and performance to the vendors they use.

The research uncovered a generally low level of detailed performance measurement and Polonious recommends detailed performance information being fed back to managers to improve referrals and find efficiencies that will drive value for SIUs. You can download the report from our website here.

SIU Insights report 2021How do you compare to other SIUs?

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