“Individual detection methods each have value but tend to produce a high false-positive rate on their own,” Ruotolo explained. “Investigating false positives is a waste of limited SIU capacity.”

Ruotolo says that the biggest challenge today for special investigation units (SIUs) is the need for a shift in thinking and methodology to address organized fraud exposure. In this interactive session, Ruotolo will discuss the pros and cons of various detection methods, how a hybrid approach can combine the best features of each detection method, and how to overcome the hurdles to implementing a fraud detection technology program.

“For years, the industry has relied almost exclusively on business rules or 'red flags' to detect suspicious claims,” Ruotolo said. “Furthermore, SIUs have been structured to handle single claim investigations. Detection and investigation of organized fraud ring activity, such as staged accident fraud, requires more advanced technology to handle the large amount of data involved.” One technique Ruotolo will discuss is breaking down silos via advanced data integration. Silos can exist in all parts of an organization and can create divisions within an SIU.