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Reducing Fraud, Waste, and Abuse in Long-Term Care Insurance: The Strategic Value of the OIG Exclusion List
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Reducing Fraud, Waste, and Abuse in Long-Term Care Insurance: The Strategic Value of the OIG Exclusion List

Insurance, Life Care, News

Reducing Fraud, Waste, and Abuse in Long-Term Care Insurance: The Strategic Value of the OIG Exclusion List

This article is part of a three-part educational series developed [...]

By Claims Bureau USA|2026-10-02T14:03:23-04:00October 2nd, 2026|Insurance, Life Care, News|0 Comments

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Background Investigation

A background investigation is a database and Internet review that covers a longer timeframe than an activity check, providing a more comprehensive report of a subject’s life. It includes searches for a current address, household members and immediate family, real property and vehicle ownership, business affiliations, professional licensure, federal and local court matters, social media profiles, and other Internet references. Based on the initial findings, there are often recommendations for additional research and strategic inquiries.

Vehicle Sightings Investigation

A vehicle sightings investigation includes a review of data from stationary and mounted cameras, such as traffic cameras and law-enforcement patrol vehicles. The results include current and historical data that show images of a vehicle and its license plate, the location and time of each sighting, and frequency of sightings. This data is used to identify potential fraud and a subject’s place of residence, workplace, frequented locations, and patterns of activity.

Geo-fencing Investigation

During a geo-fencing investigation, a virtual fence is created around any location, such as an accident scene, the location of a serious loss, or an event. Investigators then gather, review, and analyze location-based social media posts, photos, and videos to identify unknown witnesses, participants, or viewpoints and clarify other details that pertain to the claim investigation.

Medical & Pharmacy Canvasses

Calls are placed to pharmacies near a subject’s current and/or former addresses based on the provided date range. Records can be requested upon receipt of the subject’s signed authorization.

Activity Check

An activity check includes a database review, a social media and Internet search, and targeted inquiries to determine a subject’s current recreational and employment activities, including self-employment and part-time work.

Asset Check/Overpayments

An asset check determines a subject’s financial well-being and may provide evidence of overpayments. It includes a review of court matters, targeted Internet review, and review of possible assets owned by the subject, such as real property ownership and mortgages, personal property, and business ownership or involvement.

Background Investigation

Beneficiary Locate/Interview

A locate investigation utilizes databases, inquiries, and Internet investigation to find and confirm the physical address of a beneficiary. An in-person interview or recorded statement can then be obtained. This type of investigation is useful when correspondence is being returned or unanswered.

Asset Check/Overpayment

An asset check determines a subject’s financial well-being. It includes a review of court matters, targeted Internet review, and review of possible assets owned by the subject, such as real property ownership and mortgages, personal property, and business ownership or involvement.

Background Investigation

Death Claim Investigation

A death claim investigation includes an Internet review to identify social media posts, an obituary, and news reports that establish facts surrounding a subject’s death. This investigation can be paired with records retrieval to obtain a death certificate or coroner’s report, even when the death occurred internationally.

Employment Interview

These are generally in-person interviews that are conducted to obtain information regarding a subject’s employment history.

Fraud Ring Investigation

This investigation identifies patterns, trends, and scenarios under which fraud takes place. The following techniques are used to segment data for fraud detection: information retrieval, data mining, link analysis, classification, clustering, and sequence matching.

Geo-fencing Investigation

Investigative Surveillance

Surveillance efforts utilizing qualified field investigators to obtain professional-grade, high-definition video documentation of a subject’s daily routine, activities, and natural range of motion. Based on a client’s preferences, efforts are typically conducted over a two- to five-day period with shifts ranging from eight, ten, to twelve hours. Surveillance is regularly preceded by a background investigation or strategic inquiries to identify targets for surveillance and ensure an optimal return on the client’s investment.

Police, Fire, CAD & EMS Reports

Official reports, such as police and fire department records, computer-aided dispatch (CAD) reports, and emergency medical services (EMS) reports, are obtained via a records request. A subject’s signed authorization is required to obtain some records.

Social Media Investigation

This service includes a review of a subject’s social media profiles and an extensive Internet review. Frequent monitoring of the subject’s social media and Internet presence is available upon request.

Vehicle Sightings Investigation

Witness Interview

A recorded statement is obtained from a witness to assist in verifying the facts of a loss during a virtual or in-person interview.

Household Motor Vehicle Check

A household motor vehicle check verifies a subject is accurately representing their place of residence and identifies any additional insurance coverage.

Hospital/Medical Canvass and Record Retrieval

Calls are placed to hospitals and medical offices where a subject is known to have received treatment or near a subject’s current and/or former addresses based on the provided date range. Records can be requested upon receipt of the subject’s signed authorization.

Investigative Surveillance

Liability Investigation

During a liability investigation, an investigator identifies, locates, and contacts the involved parties and/or witnesses to an accident; conducts interviews and obtains statements; and gathers additional relevant information, such as police reports and photos of the involved scene or vehicles.

Neighborhood Canvass

A neighborhood canvass begins by identifying individuals who reside near a subject’s residence or business. These individuals are then strategically or directly interviewed, either in person or by telephone, to obtain relevant information about the subject, such as their schedule and activities.

Police, Fire, CAD & EMS Reports

Scarring, Residence, & Vehicle Photos

Photos are obtained to provide accurate documentation and assist in verifying the facts of a claim.

Social Media Investigation

Recorded & Signed Statements

A recorded statement is a recording of an interview regarding the facts and circumstances surrounding a specific loss. Based on the client’s preference, a recorded statement can be obtained over the telephone or in person.

Witness Interview

A recorded statement or interview can be obtained from a witness to assist in verifying the facts of a loss.

Accident Scene Investigation

An accident scene investigation is an examination of a provided loss location. It includes measurements and photos of the area and any observed defects. To assist in verifying the facts of the loss, a canvass for witnesses and/or available security footage is often conducted in association with this investigation.

Activity Check

An activity check includes a database review, a social media and Internet search, and targeted inquiry to determine a subject’s current recreational and employment activities, including self-employment and part-time work. This is often a precursor used to assist in surveillance.

Asset Check

Attorney-Represented Interviews

These in-person interviews generally take place in a law office and are conducted to obtain information regarding the facts and circumstances surrounding a specific loss or the subject’s day-to-day health and activities. Any questions provided by the client can be presented to the subject during the interview. If the subject’s attorney objects to a question, all objections are noted in the report. All Claims Bureau field agents have experience interviewing a subject while an attorney is present.

Background Investigation

Claimant Interview

These are in-person or virtual interviews that are conducted to obtain information regarding the facts and circumstances surrounding a specific loss or the subject’s day-to-day health and activities.

Court Records: Research & Retrieval

A court records investigation includes a review of a subject’s federal and local court matters. Depending on the state and court system, written requests or in-person requests may be submitted to conduct a comprehensive search or obtain a full case record.

Employment Interview

These are generally in-person interviews that are conducted to obtain information regarding a subject’s employment history.

Garaging & Residency Check

A garaging and residency check verifies a subject is accurately representing their place of residence and the parking address of an insured vehicle.

Geo-fencing Investigation

Gym/Recreational Canvass

Calls are placed to gyms near a subject’s residence and/or gyms the subject has interacted with on social media. These findings provide insight into a subject’s physical activity and provide targets for future surveillance efforts.

Hospital/Medical Canvass

Investigative Surveillance

Neighborhood Canvass

Pharmacy Canvass

Calls are placed to pharmacies near a subject’s current and/or former addresses based on the provided date range. Records can be requested upon receipt of the subject’s signed authorization.

Police, Fire, CAD, & EMS Reports

Social Media Investigation

Recorded & Signed Statements

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