How did you become passionate about fighting fraud?
My family and extended family have had the unfortunate experience of being the victims of fraud. Even more painful was that the perpetrator was a close and trusted friend and family member. My family has never fully recovered from the incident and it instilled a fire in me to catch and deter those who seek to take advantage of others for their own gain, and make sure that the ones who are successful are brought to justice.
What is a memorable case or project that you have worked on; one that made you feel especially proud?
Once I reviewed a life policy involving a series of collateral assignment requests that had come in within a couple of weeks of each other, which cumulatively exceeded the value of the policy. I noticed that a couple of the assignments were backdated and had already been recorded on the policy. There were also a few new ones — 10 in total that were all for the same amount, $1 million. This particular policy only had $1 million of coverage and I thought that we may have accepted the assignments erroneously. Further review revealed that the assignment documents were all nearly identical, however they were executed in clusters with dates that were within the same week (they were assumed to be duplicates of the same assignment). Even more interesting, the same officer at the bank signed off on all the assignments of collateral. At this point, I contacted the assignee to find out how much money had been loaned to this customer and to point out the peculiarities that I found on the forms. The officer at the bank was confused and shocked when she found out. She later advised me that $10 million was loaned to the customer by a single representative at the bank — against their company underwriting policy. They responded with a request to verify the total value of the policy they had assigned as collateral and it was my unfortunate responsibility to inform them that the policy was only worth $1 million. They then requested copies of each assignment executed in their favor by this particular officer for their legal team to review and determine the best course of action.
What types of schemes or issues do you see frequently in insurance fraud? In your opinion, how can these be tackled most effectively?
On the property claims side of things, the bigger issues are fraudulent claims and exaggerated claims (by customers and vendors alike who are trying to make extra money). Much of the time the insurance companies are left in a tough spot; an internal adjuster is often left with the choice to choose which is more expensive to the company — re-inspecting a loss to verify a supplemental claim or simply paying what a vendor is asking for. This enables vendors to take advantage of the insurance company’s position and perpetuate a culture of fraud in the wake of large disasters. Many insurance companies have chosen to put together networks of company-approved vendors that customers can use, and this helps by giving the insurer a means of oversight and/or contractual recourse over the vendors. However, insurance companies need to work to expand these networks and incentivize customers to use them.
On the life insurance side of the industry, there is a disconnect between insurers and assignees which has allowed for massive amounts of multi-lien fraud to go unchecked and unnoticed. Additionally, in many cases, better training is needed to spot forgeries and further scrutiny is needed when customers are “correcting” their tax ID numbers. There are many other issues, but these are three that are not properly recognized.
What made you interested in joining the Association of Certified Fraud Examiners (ACFE) and taking on the 90-Day Challenge?
While I was pursuing the CFCI I was introduced to the ACFE by my professors and classmates, many of whom are CFEs. After doing my research, I am convinced that those who are passionate about fighting fraud must become members. In my opinion, the training, the recognition and the knowledge base is unsurpassed anywhere in the world. The 90-Day Challenge sounded like a “fight camp” for the CFE Exam — I jumped on the opportunity.
Are there any comparisons between MMA and fighting fraud? Or, has one profession affected the way you see the other?
There are very few sports or professions in the world that are more taxing on body and mind than MMA. It requires passion, perseverance and an undying obsession with continuous learning, improvement and results. When the price for giving up or being ill-prepared quite literally could mean your life, you must be tenaciously vigilant. That mindset translates into fighting fraud. When failure and giving up are not options, you seek out additional expertise, angles, insights and details that will get you closer to your goal. MMA is so different from other combat sports in that there are so many options, so many techniques, so many ways to win and so many different styles. Mentally treating a fraudster like my opponent in the cage drives me to study, experiment, trust my instincts, be willing to accept when I am wrong, try a different approach and persist until I am victorious. (Chances are pretty good that said fraudster is not actually going to try to punch me in the face … but even if so, I’ve spent my life preparing for those moments).
What activities or hobbies do you like to do outside of work?
Outside of work, I spend much of my time training. I have gyms that I frequent and I have made a habit of seeking out and training at new gyms that practice different styles of the same martial arts. If I am not in fight camp (eight weeks of extensive training for a specific fight or tournament), then I train three to four days a week. I take one day to focus on getting stronger and all the other days are MMA-specific. During fight camp I train six days a week: four of which are MMA-specific; one day is focused on strength training and one day is focused on endurance training. I specialize in submission wrestling and I spend a considerable amount of my time training in that style. I do like to travel as well, which I get as a two-for-one deal with MMA. Last October I was in Minsk, Belarus at the United World Wrestling Grappling World Championships representing Team USA, where I won the Bronze Medal at 92kg.
I also enjoy reading, mainly nonfiction. I love reading investigative case studies, the different sciences (physics is my favorite) and business journals. Latin dance is a fantastic way to bring body and mind together as well!
Are there any lessons or words of encouragement you’d like to pass on to the future generation of fraud fighters?
Investigation is like a trade and like an art. In my opinion, the best way to learn is through mentorship. Having someone to show you the ropes and pass their knowledge and “tricks” on to you is invaluable. However, it is very important to develop your own style while also being open to criticism and different ways of doing things.
Focus on developing your skill set through programs within your university, professional certification programs, mentorships, internships and many more. There are so many ways to acquire and develop skills and to ignore any method is to your great detriment. Fraud is a huge area that involves accounting, law, data analysis, machine learning, interviewing, interrogation, research and more. The more you know your battlefield, the better you will be at detecting and deterring fraud.
ACFE membership is open to individuals of all job functions, industries and levels of experience who are interested in the prevention, detection and deterrence of fraud. If you want to level up your anti-fraud career, we can help.
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