Insurance fraud results in increased premium to State Compensation Insurance Fund’s policyholders due to having to pass on the costs of fraudulent claims and services and the cost of fraud-fighting efforts. To avoid that, State Fund designates employees as integral anti-fraud personnel and provides them with anti-fraud training to help them identify areas where fraud is most possible. Some 75 percent of State Fund employees complete this training annually.
Program Details
In this anti-fraud course, learners are exposed to State Fund’s fraud-fighting efforts and their role in helping the organization combat all types of fraud as it relates to their everyday work activities. The annual training initiative covers the basics of Workers’ Compensation fraud, red flags, and the elements to include when filing a tip that makes it actionable (reportable to law enforcement). The course also takes a deeper look at current and emerging insurance fraud trends to better equip employees to be on the lookout, identify potential threats, and take appropriate action.
This training is an interactive eLearning module where employees learn to combat fraud in a fun and engaging way as participants play the part of a “knight in shining armor” fighting fraud dragons in order to protect the State Fund Castle and its customers. Past versions of this training carried a much more serious tone, but didn’t produce results for the organization. Using a gamified, adventure-style approach to delivering this training resulted in higher engagement, better knowledge retention, and increased quality as employees rise to the challenge of protecting State Fund in their day-to-day work, just as they did in the training.
Upon completion of the training, employees are directed to the Special Investigation Unit’s (SIU) Worksite, where they are provided with reinforcement tools, additional training presentations, and success stories. Following the training, SIU works closely with the integral anti-fraud employees, coaching them on non-actionable tips submitted and providing resources and guidance for improved outcomes.
The training is released at the start of October/Anti-Fraud month each year. The team then pushes out articles, statistics, and reminders to all employees every few months following the initiative. The team also strategically places posters and digital reminders about fraud and employees’ role in fighting it on the Worksite space, and publishes articles about fraud cases State Fund has fought and won on the organization’s intranet site throughout the year.
Results
Prior to the introduction of this anti-fraud training, only 7 percent of fraud tips submitted by employees were actionable. Post-training, that number doubled to 14 percent. This increase to quality, and actionable tips being filed has allowed the SIU department to refer more than 400 fraud cases to law enforcement over the last two years, the highest number of any carrier. As a result, State Fund has had more than $69 million in restitution ordered over that time.
