Investigating and Litigating Long-Term Care Insurance Fraud – From Claim to Complaint: The Lifecycle of a Potential Fraud Claim

Insurance Partner Jessica Gallagher participated in a panel at the LTCIF Conference to discuss best practices for insurer’s fraud, waste, and abuse (FWA) programs.

The panel discussed how to properly investigate a suspected fraud, waste, or abuse long-term care insurance claim during the pre-litigation investigation stage.  The panel addressed FWA program best practices, gathering claim file information, fraud analytics frameworks, effective deployment of investigative tools, and the proper role of outside counsel.  Jessica offered strategic considerations regarding review of medical records, demanding proof of payment, thorough recertification practices, policy language enforcement, the role of surveillance and IMEs, using public records and financial records to prove fraud, the benefits of involving outside counsel early in an FWA investigation, as well as other lessons learned throughout her career.