W.V. Uses Investigation Software to Monitor Fraud Claims

West Virginia has implemented investigation management software to will enable the Insurance Commission’s Fraud Unit to monitor the growing volume of investigations and multiple investigators in various locations to collaborate and share information.

Gary Griffith, Fraud Unit director, a 23-year veteran of the West Virginia State Police, wanted to receive automatic alerts when there had been no recorded activity in an investigation for a specified period. And he wanted a system that would make it easier and far less time-consuming for his staff to produce detailed, chronological reports of their investigations and findings.

The Fraud Unit got all that, and more, when Griffith chose i-Sight Investigation Management Software from Customer Expressions’ customizable, web-based investigation software, case management and complaint-handling solutions.

According to the National Insurance Crime Bureau, insurance crime nationwide costs $20 billion a year, resulting in significantly higher premiums for consumers. In 2004, in an effort to reduce the number of cases of insurance fraud in West Virginia, the state Legislature passed House Bill 4004, which established the Fraud Division of the West Virginia Insurance Commission. The newly created division was placed under the direction of Griffith, former director of the state tax department’s Criminal Investigation Division.

The Fraud Division employs 17 experienced investigators, but Griffiths expects that number to grow to about 24 over time. In addition to investigating all types of consumer and commercial insurance fraud, including cases involving automotive, property and casualty, life, fire and disability coverage, the division recently took over responsibility for investigating suspected cases of fraud in West Virginia’s workers’ compensation system.

In the past, suspected cases of insurance fraud in West Virginia were typically handed over to state or local police for investigation. Provided there was enough evidence to warrant charges, the case would then be referred to a prosecutor. The task of logging and managing all of those cases “was basically just done with a paper filing system and human memory,” Griffith said.

After taking charge of the Fraud Unit, Griffith began to look for investigation management software that would enable his team to electronically record every case and every step of their investigations. He consulted a former West Virginia senior State Trooper who works at the National White Collar Crime Center in Richmond, Va.

“He told me there were a lot of case management systems out there, but the ones he’d seen all had drawbacks of one kind or another,” Griffith said. “Some are really just case tracking systems. I wanted something a lot more intelligent, something that would give me the ability to look at a case in real-time and make sure nothing gets left behind.”

Eventually, another former colleague recommended that Griffith take a look at the case management system that was already in use at the West Virginia Workers’ Compensation Commission, whose investigative responsibilities were about to be transferred over to the Fraud Unit. That system used i-Sight Investigation Management Software from Customer Expressions.

“I arranged for a demo of i-Sight and I could see right away that it did a lot of the things I needed,” he said. Better yet, Griffith learned that the i-Sight system was fully customizable, so it could easily be modified to meet the Fraud Unit’s exact requirements.

It didn’t take long for him to decide that i-Sight was the solution he had been looking for. Within weeks, the development team at Customer Expressions produced a customized version of i-Sight, and field trials got underway. After further refinement, the completed system went live on Sept. 1, 2005.

From Griffith’s standpoint, the i-Sight investigation software offers a number of key benefits. For one thing, the software is remotely hosted by Customer Expressions, so maintenance is not a concern. The fact that it is web-based means that users can access the system securely from the office, at home or on the road; the only requirement is a computer and an Internet connection (dialup or better). And i-Sight is simple to use, so training time for staff members is minimal.

“Some of our cases might involve three or four investigators in different parts of the state,” Griffith said. “With i-Sight, they can each enter their own information separately in the case file and it will all be logged in chronological order. I or any other manager can go in and see the status of a particular case, offer suggestions and direction, see how much time our people have spent working on a particular case, and have everything documented in real-time.”

Accuracy is another important consideration. “In the past, the lead investigator or somebody else would have had to sit down and manually go through all of the information in a file in order to write up a summary. It was very, very time-consuming, which meant that people often got frustrated and took shortcuts. With i-Sight, you just press a button and the system spits out a complete written report. It saves a lot of man-hours and eliminates duplication of effort. And the final result is more accurate.”

At Griffith’s request, the i-Sight software was configured to send him automatic alerts based on specified triggers, such as when there has been no activity on a case for 30 days. “That’s important because it means I can take a look at the case and make sure there are no problems that are getting in the way of our investigative work. It gives me much greater supervisory capability. I can see the whole case at once instead of just bits and pieces.”

Using i-Sight’s built-in reporting capabilities, Griffith and his team can also analyze the Fraud Unit’s caseload to detect patterns of insurance abuse and plan their strategies accordingly. Over time, he said, that should allow them to become much more proactive in dealing with fraudulent behavior.

“I had been looking for investigation management software that offered all of these features, and i-Sight does exactly what we need,” Griffith adds. “I am sure that anyone who manages a large volume of cases would be interested in a system like this.”