Audit Compliance
Our SIU audit compliance activity is important to ensure that your company’s insurance claim files are being correctly referred and that your employees are following the proper anti-fraud procedures in handling claim files. Llorente SIU conducts an onsite audit compliance for our clients to determine whether suspect claim files are being red flagged and referred to the company’s special investigations unit. In some states, this is required by state regulations. Some states also require your company to implement a fraud plan and document the details showing that employees are following the plan’s guidelines for flagged case referrals to your SIU.
The investigation, analysis and referral of red-flagged claim files for suspicious activity are Contract SIU services that we do best. We can determine whether or not the evidence exists to prepare the case (a case package) as a criminal referral to law enforcement for the prosecution of insurance fraud (a documented referral). When a case file is lacking in evidence, we will give your personnel a list of additional evidence that needs to be obtained and an action plan for obtaining the evidence. Llorente SIU will continue to monitor each case file as the evidence is documented. Once the case is ready to be prosecuted, we’ll prepare the documented referral to law enforcement. When needed, we can continue to track the case through conviction, sentencing and restitution.
We understand why insurance companies get nervous when they are being audited. There’s a lot at stake for your company. Many states slap heavy fines on insurance companies for non-compliance with state regulations and can even restrict or forbid an insurance company from writing policies in that state. You may have seen the phrase “SIU Audit” used to describe a state regulators audit of an insurance company’s special investigations unit. When you are a client of Llorente SIU, it is our program that is being audited and we answer to the state’s Department of Insurance Fraud Division for you. We’ve been through state audits in the past and have always passed them successfully.
Increasing prosecutions for insurance fraud is important for any SIU program. We believe that a timely audit of your claim files is a crucial step in making certain your company is correctly identifying all your criminal insurance fraud cases. Llorente SIU has the experience and track record to significantly increase the chances of getting your insurance fraud cases filed. We have compiled a summary of the most important improvements that your company can take in investigating, packaging and presenting cases to law enforcement to obtain the best possible results. Use our website’s convenient Contact Us feature to leave your name, address and email information to receive a free copy.