Archive for February, 2015

Swoop & Squat: Don’t get bent over by insurance fraudsters

a swoopIt was on June 17, 1992, that the phrase swoop & squat became a household name. Long before this date, this form of staged accident was common place on the highways and byways of Los Angeles where I was a claims investigator. But this day will live on in infamy as the day that this vernacular went viral.
The catalyst was an accident that occurred on the 5 freeway in the San Fernando Valley, just north of Los Angeles. A black Firebird had been rear-ended by a semi, that subsequently jack knifed and dumped its load of cars across the freeway.

In the Firebird, passenger Rubidia Lopez had been partially ejected and was seriously hurt, requiring the Jaws of Life to save her. One of the other passengers, Jose Perez, was not quite so lucky, losing his life in this vain attempt to cash in on the truck’s lucrative insurance policy. It was this accident that brought nationwide attention to organized crime rings that stage swoop and squats from coast to coast.

While there are various iterations of the infamous swoop and squat, the common theme is to target vehicles with large insurance policies such as luxury cars or commercial vehicles. The squat car is stuffed with passengers who have been paid by a “capper” to perform the feat of slamming on their brakes in order to get rear-ended. In order to make the story plausible, a swoop car is usually involved. When the squatter positions their car in front of the intended target, the other vehicle swoops in and hits their brakes making the squat cars story believable. In more complex schemes, other vehicles are used to pull alongside the intended target so as to impede any ability to change lanes.
The organized criminal enterprise usually has a hierarchy. The bosses tend to be professionals, such as doctors and lawyers. They work with the cappers who identify the parties to take part in swoop and squats and other forms of staged accidents.

The claimants are often poor, frequently illegal immigrants, and looking for an opportunity to make money. The cappers fulfill this need by paying them a sum of cash, usually a few hundred dollars each, to be hit by another car. The capper provides each of the parties with a “script” so that when questioned by law enforcement or claims adjusters, there are no discrepancies.
The capper then sells the rights to the claim to the lawyer at the top of the hierarchy. The lawyer refers the claimants, or people who were in the squat vehicle, to a medical provider. The medical provider will document, fraudulently, that they performed a number of diagnostic and therapeutic procedures on the claimants. In many instances the claimant never goes to the medical facility or meets the doctor.

The 1992 case took on a different twist, as the investigating officer believed that this was not only a staged accident but that there was sufficient evidence to pursue the lawyer who orchestrated the entire charade. According to various investigative reports, the officer’s investigation led him to the Beverly Hills office of attorney Gary Miller. Prosecuting attorney’s involved in fraud is always a challenge, as the attorney will invariably say “I didn’t know this was a fraudulent claim.”

During the course of his probe into Miller, the investigating officer enlisted the help of an insurance investigator who wore a wire and captured damning information directly from the attorney. Miller was arrested and charged with conspiracy and second degree murder, along with several other people involved in this particular staged accident ring.

Records from the California Bar show that Miller was ordered to stop practicing law and some four years later resigned from the state bar. After the jury deadlocked on the second degree murder charge, prosecutors refiled as a lesser charge and the attorney pled no contest to involuntary manslaughter and received a six year prison sentence. He was also convicted of nine other felonies for insurance fraud and conspiracy and received a concurrent six year term.

Investigative records show that Miller typically cleared up to $20,000 dollars for each crash, netting over $1.6 million in the year prior to his arrest. The claims nearly always involve soft tissue injuries which are hard to disprove. So the question is how we, as claims investigators, effectively fight swoop and squats and other staged accidents.

It’s tough. While most attorney’s and medical providers are law abiding, the reality is that there is a subset of each profession that are involved in such scams from coast to coast, yet only a handful of prosecutions, making success seem akin to finding a needle in a haystack.

In my insurance fraud thriller Swoop & Squat, many of the insurance related scams were based on person experience gained during my years of investigating fraudulent claims in South-Central Los Angeles. To be successful, an investigation needs to be highly detailed and well documented.

The first critical element is to inspect the damaged vehicles. If the damages, paint transfers or metal striations don’t match, the collision probably never took place. These are the easiest claims in the staged accident realm to disprove. Of course, in a classic swoop & squat, the damages will match because the accident actually happened.

The next key step is to look for patterns of known associates. Each of the claimants probably has prior claims, as cappers tend to recycle their clientele. Sometimes they are drivers, other times passengers and at others witnesses. They all have a role cast in these sordid tales. Index returns will often provide some basic insight, as will link analysis tools.
Demanding to speak to the claimants is critical. Attorneys will often fight this request, but the reality is that everyone can be deposed should the matter be litigated. The claimants will be forced to sit down and recount the tale of what happened, and truth be told, many of these claimants will disappear.

When the attorney capitulates, it is important that these statements be in person. Invariably the claimant will take out the script to recount what transpired. Simply taking away that script can be enough to not only throw the claimant off their talking points but to convince the attorney to drop the claim.

Even if they refuse to give up the script, or don’t have a script, asking basic questions can yield a similar result. What did the doctor look like? Describe the medical facility? How did you get from you home to the doctor’s office? These are basic questions to which the claimant will not have a good answer. Another trick of the trade is to carry photographs of random people in doctor coats and show them to the claimant and ask them to point to their medical provider. They usually get it wrong and the claim often goes away.

Clinic inspections are another key tool in the investigation process. Some clinics will allow these, while others will resist. Having a medical authorization is very important and cannot always be obtained short of litigation. During my years investigating clinics, we often traveled in pairs. Aside from these potentially being dangerous criminal enterprises, splitting the attention of the clinic administrator was crucial.

In one instance, my partner was gathering copies of the clinic sign in forms in order to compare signatures and look for evidence that all the forms were signed on a single date. I used this as an opportunity to snoop around the clinic, unattended. After capturing photographs of unplugged and inoperative equipment that could be used to not only deny the claim, but likely get an active state fraud investigation going, we were confronted by staff in the clinic who threatened us if we did not give them the film. After a physical altercation, we managed to get out of the clinic and turn the evidence we had gathered over to both SIU and law enforcement.

Another key step is to actively canvass the neighborhoods where the claimants live. Talking to neighbors can yield a significant amount of information. In addition, digging into claimant history and talking to ex-spouses can provide telltale clues as to whether or not you are dealing with potentially fraudulent claims. Of course, any claimant should also have their criminal records checked, as these can provide not only valuable information to impeach credibility, but can highlight prior convictions for various types of fraud or other illegal activity.
The reality is that proving fraud is hard, especially when there is real damage, as in the case of a swoop & squat. Often the best hope is to convince the attorney that dropping the claim is in their best interest. Attorneys and medical providers are largely shielded from prosecution due to simple plausible deniability.

The more information that can be gathered to link attorney, provider, capper and claimants together, the higher the probability of success. The perpetrators of insurance fraud don’t like aggressive investigations. Just as they are well aware of who does and does not reduce medical bills, pay for hot packs or assess comparative negligence, they are aware of carriers that are tough to deal with. Carriers should strive to be in that bucket, as effective investigative tactics tend to keep at least some of the fraudsters at bay.

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Christopher Tidball is an executive claims consultant and the author of multiple books including the thriller Swoop & Squat and Re-Adjusted: 20 Essential Rules To Take Your Claims Organization from Ordinary to Extraordinary! To learn more please visit http://www.christidball.com.

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February 27, 2015 at 5:43 pm Leave a comment


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Chris Tidball is a claims and revenue management consultant and author of the "20 Essential Rules" series of self and organizational improvement books. You can ask him a question at chris@christidball.com

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