“Insurance fraud is a continuous game of cat-and-mouse,”explains James Quiggle, director of communications for theCoalition Against Insurance Fraud (CAIF). “Investigators build amouse trap, but then swindlers build a better mouse. The industry'sbest defense is amassing field intelligence and analysis and thenthrowing that up against a ring.”

While detection and investigationhave become far more scientific, the technology and methods areonly as effective as those utilizing them. Staff must be apprisedof proper data-mining techniques, and the insurer must be willingto cultivate a system-wide awareness of fraud at all levels of thecompany and programs for identifying and disseminating clues to thespecial investigative unit (SIU).

“Going after fraud simply doesn't fall on the shoulders of SIUalone,” says Quiggle. “There must be a companywide commitment andtraining throughout all layers of the corporation. Information thatmay contain clues is coming from all directions, so adjusters,underwriters and even customer-service reps must all be trained infraud detection and uniform protocols to share that data.”