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    CFE Tackles Insurance Fraud 

    Mary Durden, CFE, FCLS 

    Special Investigations Unit Field Analyst 

    GEICO  

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    Mary Durden, CFE, FCLS, has enjoyed a long tenure at insurance giant GEICO. Beginning as a customer service representative, she found her calling as a special investigations unit (SIU) field analyst. Since embarking on that career path, she has investigated and assisted in the prosecution of hundreds of fraudsters.


    How did you first become passionate about fighting fraud? 

    I began working at GEICO shortly after completing my bachelor’s degree in 1998. During the first six years of my career, I worked as a customer service representative, a staffing analyst and a claims liability adjuster. While a liability adjuster, the SIU Analyst position was created and I applied for it after a supervisor in my department suggested that I should. Shortly after beginning my position, I worked a large, complicated case and knew I had found something I loved to do. I enjoy problem solving and analyzing data, so being a fraud analyst is the best of both worlds.


    As part of your role, you’ve assisted in criminal investigations. What are some of the unique challenges that other CFEs might not anticipate when dealing with the legal outcomes of fraud investigations? 

    One of the largest differences between investigations and criminal prosecution is the time frame involved and how far out some of the criminal investigations can stretch — especially when multiple carriers are involved in an investigation. It’s important to realize that even though the insurance fraud investigation by the carrier is completed, law enforcement still has to conduct their own separate investigation as well as collect evidence and other valuable intelligence from the involved carriers. Once the criminal investigation is completed, it can then take some time between the completion and the subject being arrested and facing a judge for the first time to start that process. We have had several large ring investigations during my tenure at GEICO where it was more than two years from the time the SIU case began until warrants were issued for those involved.


    Is there anything unique about insurance fraud that sets it apart from fraud in other industries?
     

    Insurance fraud is unique in that it is difficult to accurately predict the amount of fraud that occurs and the exact value of the money stolen through insurance fraud. The main reasons for this lack of knowledge are that much insurance fraud goes undetected and no single national agency gathers fraud statistics. Insurance fraud data is somewhat fragmented, making our knowledge of it a continuing work in progress. Insurance fraud is also unique in that it can be perpetrated by many different parties such as the insurance applicant, third-party claimants, policy holders and the professionals who provide services and equipment. Additionally, insurance fraud is often committed by individuals who would never consider violating the law in a more traditional sense.

    One thing that is becoming more prevalent is the migration to insurance fraud from suspects usually involved in other fraud or criminal activity. We have worked rings in the metro Atlanta area being perpetrated by street gangs which in years past would focus on drug dealing and other criminal activity. Because of tightening penalties for arrests of that nature, the groups have moved into insurance fraud and the staging of accidents.


    What is a memorable case or project that you have worked on; one that made you feel especially proud?
     

    In 2011, I worked a case with the National Insurance Crime Bureau (NICB) and the Georgia Bureau of Investigations (GBI) that I will never forget. Because of a tip from the NICB that a particular vehicle had been involved in many GEICO claims, I began to investigate the claims and the individual perpetrating the fraud. She was initially hard to track because she continued to purchase new policies in fake names with fake information, but I quickly figured out that she always used one of three email addresses. I searched our claims data every day for those email addresses to ensure that we did not pay her any additional money on fraudulent claims. Because the subject had a lengthy prior criminal history and was on parole at the time of her fraud against GEICO, the GBI prosecuted her on a federal level and she was sentenced to six years in prison. Not only did I learn a great deal about federal laws, I also realized the importance of proactively searching for fraud.


    What is one of the biggest lessons you have learned since becoming a CFE?
     

    One of the biggest lessons I have learned since becoming a CFE is that fraud is much more prevalent, in all industries, than I had ever thought. Through the articles in the ACFE’s Fraud Examiner newsletter and Fraud Magazine, I have learned not only how widespread it is but how much of it is missed until it has become a huge problem. We had already begun proactive measures in my department before I obtained my CFE, but now I put a great deal of thought and research into what fraud we might be missing and how it can be identified.


    How has membership in the ACFE impacted your professional development?
     

    After spending many years focusing on my career development, in January 2017 I decided it was time to further my education by obtaining my CFE and beginning my pursuit of a master’s degree in analytics. My ACFE membership and CFE credential have expanded my knowledge beyond insurance fraud and exposed me to different perspectives regarding fraud. Pursuing a master’s degree has shown me new ways to detect fraud in large amounts of data through the use of advanced tools and data analysis techniques.


    What activities or hobbies do you like to do outside of work?
     

    When I am not completing homework for my master’s program, I enjoy home improvement projects, gardening and fun activities with my two children.