Health and dental insurance coverage is a benefit offered by many employers, both large and small. The plans and coverage vary with the employer, but one thing they all have in common is that they can be targeted for fraud. This can range from a plan member submitting fabricated receipts to clinics offering cash or merchandise instead of medical supplies or treatments. This session will cover the most common fraud schemes and one insurer’s response to the problem.
Andrew Kautz, CFE Manager, Special Investigations Unit, Great-West Life Assurance Company
Andrew manages an Investigative Unit for Great-West Life based in London, Ontario. He has more than 30 years of experience conducting fraud investigations. His work has taken him across Canada and into the United States investigating frauds ranging from a few hundred to several million dollars, including loan frauds, Ponzi schemes, phony vendor scams and health care fraud. In addition to investigation, Andrew pursues recovery from perpetrators as well as third parties that may have played a role in the fraud scheme. These efforts include the recovery of funds from Nigeria that had been sent to this country by a dishonest employee in response to one of the infamous Nigerian Letters.