Arson: The Complete Investigator's Manual. Boulder, CO: Paladin Press, 1990.Call Number: HV 8079.A7A78 1990Abstract: Provides arson investigators with a practical instrument to assist during the investigative stages that follow the identification of the "cause and origin" of a fire. Has a "red flag" checklist that may indicate insurance fraud.

"New DOJ/OIG Guidelines Set Limits for Fraud Investigations." Healthcare Financial Management (August 1998): pp.10-11.Notes: Available fulltext on InfotracAbstract: The Department of Justice (DOJ) and the HHS Office of the Inspector General (OIG) issued separate guidelines on healthcare investigations in response to Medicare fraud. The two sets of guidelines represent a major change in the government's approach to investigating healthcare fraud and abuse.

Anthony, Alanna. "Putting the Hurt on workers' compensation fraud." Risk Management (October 1998): pp. 33-36.Notes: Available fulltext on WilsonWebAbstract: It is essential to be able to recognize the signs of fraud to know if, when and how to proceed with claims investigation and mitigation.

Bernstein, Andrew J., et al. Fraud: The Hidden Cost of Health Care. Washington, DC: Health Insurance Association of America, 1996.Call Number: RA 395.A3F696 1996Abstract: Health care fraud investigations involve many legal issues. Understanding these issues will ensure that investigative activities are conducted within proper legal boundaries. The goal is to maximize the impact of anti-fraud activities while minimizing the legal risks that insurers and insurance investigators face as a result of conducting aggressive fraud investigations.

This bibliography is a representative selection of materials either owned or on order by the FBI Academy Library. Inclusion of an item does not represent an endorsement by the FBI of the material or its author.

Berry, Dennis. "Ten Strategies to Avoid Government Fraud Investigation." Preventing Business Fraud (February 2000): p. 10. Notes: Available fulltext on LEXIS/NEXISAbstract: The author cites his top 10 strategies for health care providers to avoid running afoul of the federal government on such issues as billing for Medicare services. This advice holds true for all kinds of corporations and organizations.

Bradford, Michael. "Vigilance Gaining On Work Comp Fraud." Business Insurance (October 25,1999): p. 41.Notes: Available fulltext on WilsonWebAbstract: Employers, third-party administrators and insurers can do a lot to prevent workers' compensation fraud just by making sure incidents are reported.

Chesson, John B. "Fraud Law Casts a Wide Net." Best's Review (March 1998): pp. 55, 58.Notes: Available full text on WilsonWebAbstract: The Insurance Fraud Prevention Act (IFPA) greatly extends the reach of federal investigators, prosecutors and courts, while also giving them a strong mandate to pursue charges of mismanagement, fraud and financial wrongdoing at insurers doing business with policyholders in the United States.

Consumer Insurance Guide. "Fraud Takes Toll On Your Insurance Rates: Auto Fraud Most Challenging." August 1998. [http://www.insure.com/gen/autofraud.html]. March 2000.Abstract: While every kind of insurance fraud can be difficult to combat, auto insurance fraud can be particularly challenging.

Coward, Cheryl. "Battling Insurance Fraud." Black Enterprise (March 1998): p. 101.Abstract: Consumers should be aware that fraud can increase insurance premiums, so whether you are buying auto, homeowner's or other insurance, you should take steps to prevent yourself from becoming a victim.

Fletcher, Meg. "Fighting Insurance Fraud: Investigate All Suspicious Claims." Business Insurance (November 1,1999): p. 56.Notes: Available fulltext on InfotracAbstract: Reports on the remarks of a panel of experts discussing fraud in the workers' compensation system.

Gastel, Ruth. "Insurance Fraud." III Insurance Issues Update (December 1999).Notes: Available fulltext on LEXIS/NEXIS Abstract: Property/casualty insurance fraud totaled an estimated $21 billion in 1998, or about 10 percent of claims. Common frauds include "padding" or inflating actual claims, misrepresenting facts on an insurance application, submitting claims for injuries or damage that never occurred, and "staging" accidents.

Hays, Daniel. "High-Tech Could Both Facilitate, Thwart Frauds." National Underwriter (December 1999): pp. 20-27.Notes: Available fulltext on WilsonWebAbstract: Twenty-first century battles between insurance scam artists and fraud investigators will see both sides making greater use of computer technology, with the good guys having the edge.

Jesilow, Paul, et al. Prescription For Profit. Berkley, CA: University of California Press, 1993.Call Number: RA 412.5.U6J47 1993 Abstract: No one has been able to calculate the precise cost of fraud and abuse associated with Medicare and Medicaid, but every year about two hundred physicians are suspended from participation in these programs because of fraudulent and abusive practices.

Kizorek, Bill. "SURVEILLANCE: Claims Investigators May Face Backlash." Risk Management (May 1998): pp. 43, 46.Notes: Available fulltext on WilsonWebAbstract: Conducted properly, surveillance can be the soundest way possible for risk managers to identify and document fraudulent claims.

Kleiner, Shari G., et al. "Health Care Fraud." American Criminal Law Review (Summer 1999): pp. 773-807.Abstract: The current state of the law covering federal health care fraud and its enforcement are examined, as are efforts to investigate and prosecute this type of fraud.

Levin, Amanda. "Compliance Programs Stop Health Care Fraud." National Underwriter (December 7, 1998): pp. 7-8.Notes: Available fulltext on WilsonWebAbstract: To avoid penalties stemming from health care fraud and abuse, companies should have a comprehensive compliance program in place along with a professional liability insurance policy.

Miller, Theresa. "Vehicle for a Swindle." Best's Review (September 1999): pp. 44-46.Notes: Available fulltext on Wilson Web Abstract: As guarantors in 41 states clean up after Martin Frankel, the bond trader who allegedly drained several insurance companies' assets, regulators have begun to figure out how to prevent another scam of this caliber.

Nessim, Ronald J. and Elizabeth A. Newman. "Using the Eighth Amendment to Attack Civil False Claims Act Penalties in Health Care Fraud Cases." Criminal Justice (Fall 1999): pp. 20-23.Abstract: In a health care fraud case, fines levied under the Civil False Claims Act can easily mount up to levels far in excess of the actual damages, and they may violate the 8th Amendment's prohibition on excessive fines.

New Times Los Angeles. "Auto-Fraud Investigator." April 1999. [http://newtimesla.com/1999/42299/feature1-3.html]. March 2000.Abstract: Relates his firsthand education as a result of having spent more than a decade infiltrating accident rings.

Panko, Ron. "Getting a Jump on Crime." Best's Review (October 1999): pp. 73-75.Notes: Available fulltext on WilsonWebAbstract: New technologies give insurers the information they need to take a stand against fraud.

Pathria, Anu. "Advanced Fraud Detection." Risk Management (March 1999): pp. 23-24+.Notes: Available fulltext on WilsonWebAbstract: To date, the primary emphasis in battling fraud has been on review, with a focus on surveillance, investigation and prosecution. However , the challenging task of effectively identifying suspects in the first place has received less attention, even though it currently offers the greatest opportunity for minimizing losses associated with fraud.

Piccinini, Carina. "Mission Possible: Nab International Export Rings." 1999. [http://www.allstate.com/news_issue1/auto/auto_2.html]. March 2000.Abstract: Welcome to the world of the Outbound Enforcement Team. The team works together toward a common goal, preventing international auto thefts.

Roberts, Sally. "Insurers Gaining Ground Against Health Care Fraud." Business Insurance (September 1999): pp. 32B-6B.Notes: Available fulltext on InfotracAbstract: Discusses fraud in the health care insurance industry. Includes statistics of losses caused by fraud and information about types of fraud committed.

Rundquist, Kristina. "Beating Fraud at Its Own Game." Occupational Hazards (September 9,1998): pp. 61-62.Notes: Available fulltext on WilsonWebAbstract: workers' compensation fraud has become a national pastime. Too many people see beating the system as a working man's victory with a couple of weeks' vacation thrown in for good measure.

Samborn, Hope. "Relying On RICO." ABA Journal (May 1998): p. 30.Abstract: Using civil racketeering laws, insurers collect big damages from attorneys and others who aid insurance fraud.

Snyder, Lynn. "Agents: Watch Out For "Red Flags" On Fraud." National Underwriter (September 1999): pp. 10-11+.Notes: Available fulltext on WilsonWebAbstract: Insurance agents and brokers who watch for "red flags" during the policy application process can play an important role in controlling fraud and abuse. The article list indicators to watch for.

Sparrow, Malcolm K. License to Steal. Boulder, CO: Westview Press, 1996.Call Number: RA 395.A3S764 1996Abstract: Health care fraud and abuse, whether perpetrated against public or private programs, hurts those who are least able to protect themselves, our children, our elders, our poor and our disabled. The cost of this crime also manifests itself in higher insurance premiums.

Wilson, Behn and Michael Dunne. "Shutting Down the Shams." Security Management (September 1998): pp.67-70.Abstract: Most organizations can benefit from establishing an insurance fraud prevention program.

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