Guarding Against Insurance Fraud in the Digital Era

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Slide, Wednesdays with Woodward (registered trademark) Webinar Series. 

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JESSICA KEARNEY: Good afternoon and thank you so much for joining us. My name is Jessica Kearney, Vice President here at the Travelers Institute, which is the public policy division and educational arm of Travelers. And I'm pleased to be filling in today for our host, Joan Woodward. 

So welcome to our deep dive on all things talking about the evolution of insurance fraud, especially in the digital era. We're going to be looking at the latest trends this year, what we're seeing and, importantly, what we can all do as consumers, as business owners and insurance professionals to make sure that we stay vigilant.

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Slide, About Travelers Institute (registered trademark) Webinars. Text, The Wednesdays with Woodward (registered trademark) educational webinar series is presented by the Travelers Institute, the public policy division of Travelers. This program is offered for informational and educational purposes only. You should consult with your financial, legal, insurance or other advisors about any practices suggested by this program. Please note that this session is being recorded and may be used as Travelers deems appropriate. Logo, Travelers Institute. Travelers. Slide, Wednesdays with Woodward (registered trademark) Webinar Series. Text, Guarding Against Fraud in the Digital Era. Logos, C.B.I.A., Travelers Institute, Travelers, Coalition Against Insurance Fraud, Professional Insurance Agents, University of South Carolina Darla Moore School of Business, University of Connecticut School of Business M.S. in Financial Technology, MetroHartford Alliance, Insurance Association of Connecticut. 

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Before we get started, I want to extend a huge thanks to our co-hosting organizations, as always-- the National Association of Professional Insurance Agents, the Insurance Association of Connecticut, the Master's in FinTech Program at UConn School of Business, the Center for Risk and Uncertainty Management at the University of South Carolina's Darla Moore School of Business, CBIA, the MetroHartford Alliance, and we're going to hear a lot more about this organization coming up over the next hour, the Coalition Against Insurance Fraud. 

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Slide, Speakers. Three portraits of speakers. On the left is a woman with long blond hair. Text, Jessica Kearney, VP, Public Policy, Travelers Institute, Travelers. In the middle is a woman with blond hair pulled back in a low ponytail. Text, Michelle Rafeld, Executive Director, Coalition Against Insurance Fraud. On the right is a man with short dark hair. Text, Pranay Mittal, Vice President, Travelers Investigative Services. 

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Today, we're going to start with some opening presentations from two really fantastic speakers, followed by a moderated conversation and your questions. So get your questions ready. Drop them in the Q&A throughout the program, and we'll get to as many as we can. 

So with that, let's get started. First up will be Michelle Rafeld. She is the newly appointed Executive Director of the Coalition Against Insurance Fraud, which I just mentioned, an organization of consumers, insurers, government agencies, prosecutors and others, all uniting to fight fraud. She stepped into this role in January 1st of this year, bringing an extensive career in the insurance industry and advocating for fraud prevention.

As just a few examples, she served as Fraud Director for the state of Ohio. She's led local, state and national collaborative efforts for industry and consumer protection. She's represented the National Association of Insurance Commissioners, NAIC’s Anti-Fraud Task Force. And she served on the National Insurance Crime Bureau's Law Enforcement Advisory Committee.

Then, next up, we're going to hear from Pranay Mittal, who leads Travelers' own Investigative Services within our Claim organization. His group is responsible for investigations into insurance fraud, fire, cargo theft and other areas. Pranay previously served in Travelers' Claim Analytics and Technology organization, among other roles. And he's held numerous other management positions within the industry, with responsibility for strategic business and technology initiatives.

With that, I am so pleased to turn the floor over to Michelle Rafeld for her opening presentation. Welcome, Michelle. The floor is yours.

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Slide, Guarding Against Insurance Fraud in the Digital Era. A hooded figure set against a background of 0s and 1s is on the right, looking over an array of smart device and laptop screens. Logo, Coalition Against Insurance Fraud. 

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MICHELLE RAFELD: Thank you, Jessica, and a special thank you to all of you for tuning in to today's webinar. We're in an era where basically there's an app or program available to help with anything we may need. And every type of information you could possibly think of is out there for the taking. So the insurance industry is really at a crossroad when it comes to technology and data. 

Because technology advancements have enabled insurance carriers to streamline business processes and enhance consumer experiences, those same technology advancements have made it easier for individuals and sophisticated criminals to commit insurance fraud. And as I'm going to touch on today, the need for insurers and consumers and government organizations to unite and collectively fight it has never been greater.

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Slide, What is Insurance Fraud? On the right are a multitude of light blue question marks. Text, The intentional providing of false or misleading information, or withholding material information, as part of an insurance transaction.

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So, I'm often asked, what is insurance fraud? Well, to put it simply, it's the intentional providing of false or misleading information or withholding material information as part of an insurance transaction. 

Insurance fraud isn't someone forgetting to disclose a medical condition or procedure they had 20 years ago, or even giving incorrect information when trying to recall something from memory. It's an intentional act where someone knowingly provides false or misleading information in the hopes of financial gain. And here in the U.S., it's a crime in almost every state.

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Slide, The Cost of insurance Fraud. A hand disappears in a sea of 100-dollar bills. On the left is a pamphlet cover with the United States Capitol building and flag sinking into 100-dollar bills, with the title, The Impact of Insurance Fraud on the U.S. Economy 2022. Text, $308.6 billion annually. 

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Now, I have to say, insurance fraud isn't new, and you probably all knew that. In fact, the first ever reported insurance fraud case goes back to ancient Egypt, where a gentleman bought a boat, intentionally sank it, and then tried to collect the insurance money. 

And that still happens today. People hide their cars and claim they were stolen. They'll ransack and damage their homes to claim they were robbed. And they'll even set fire to their homes when facing foreclosure. And what you may not realize is every line of insurance has its own unique set of fraud schemes because there's no type of insurance that's immune from fraud.

I also want to point out that insurance fraud is complex, and it’s always evolving. There are new schemes always being identified. And Pranay is going to discuss that in greater detail in just a few minutes. 

Now as I mentioned earlier, the need for organizations to unite and collectively fight insurance fraud has never been greater. Approximately two years ago, the Coalition, with the help of Colorado’s University Global and numerous strategic partners, conducted a study to determine the cost of insurance fraud today.

And I have to say that when we unveiled that figure to our members, their jaws absolutely dropped because no one anticipated that number to be $308.6 billion annually. And the scary thing is, that number continues to increase with each passing year.

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Slide, What can $308.6 billion buy? A picture of a graduation cap labeled, 12.3 million college educations. A picture of a car labeled, 4.1 million Chevy Suburbans. A picture of houses labeled 880,000 homes in the U.S. -- A picture of the Empire State Building labeled, 134 Empire State Buildings. A picture of a jet labeled, 5,128 Gulf Stream Jets. A picture of a football stadium labeled 250 N.F.L. stadiums. 

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Now, to put in perspective just how much is lost to insurance fraud each year, $308.6 billion today will buy you 134 Empire State Buildings, 250 NFL stadiums, over 5,100 Gulfstream jets, 4.1 million Chevy Suburban trucks, 12.3 million college educations, and 880,000 middle-class homes here in the U.S. 

Think about all we could do as a nation to tackle the homelessness problem in this country if we had an added $300 billion a year available. So hopefully that helps all of you realize just how significant this problem really is.

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Slide, The Cost of Insurance Fraud. A man frowns as money flies out of his wallet and burns up. Text, $932.63. The average cost every American pays for insurance fraud. 

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Now, while many of you joining us today work in the insurance industry, it's important for all of you to realize you are consumers. And so how does it make you feel to know insurance fraud costs each and every one of you on an annual basis over $932? 

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Slide, The Cost of Insurance Fraud. Dark silhouettes of a two-parent, two-child family stand on burning money. Text, $3,750.52 per year for the average American family. $73,491.24 per American over the average lifetime. 

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For those of you who have families, insurance fraud costs the average American family more than $3,700 per year. And in today's day and age, when things are so incredibly expensive, just think what a family could do with that extra money. 

And then finally, during the course of an individual's lifetime, insurance fraud is estimated to cost them more than $73,000. So as you can see, insurance fraud is truly the crime that we all pay for.

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Slide, Consumer Attitudes Are Changing, And not for the better... A pamphlet on the left has a human brain on a web of colorful neon strings and chalkboard math equations. It is titled, Who Me? Who Commits Insurance Fraud and Why. On the right are pictures of five people posing with their hand touching their chin, looking up in thought. 

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Now, after the Coalition concluded its study on the cost of insurance fraud, we conducted another study to gauge consumer attitudes towards it. And those results were also as shocking, as the study confirmed consumer attitudes are changing, and not for the better. 

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Slide, 50 Million Don't View Insurance Fraud As A Crime. A picture on the left shows a man quirking one eyebrow. On the right is a bar chart titled, Do you consider insurance fraud to be a crime? On x-axis are the age groups, 18 to 24, 25 to 34, 35 to 44, 45 to 54, 55 to 64, and 65 plus. On the y-axis are percentages from 0 to 100 in increments of 20. Dark blue bars show the lower age groups around 65 to 75%, with the older age groups around 95%, and a light blue horizontal line shows the average at 84.25%. 

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In fact, approximately 15% of those surveyed didn't even view insurance fraud as a crime. What was even more bothersome is they found committing insurance fraud to be acceptable and said it was something they'd be willing to engage in. And that should concern you because when you apply that percentage to the country's overall population, it means that there are over 50 million Americans who don't view insurance fraud as a crime. 

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Slide, Especially Those 45 & Under. A picture on the left shows a man squinting to the side. A bar graph is titled, Compared to crimes such as tax fraud or stealing, my view on insurance fraud is: The x-axis and y-axis are the same. The bars are colored in shades of blue from lighter to darker, labeled as follows: punish equally, punishment should be more severe, punishment should be less, business practice and not a real crime. The darker sections take up more of the bars on the younger age groups. An arrow points to the younger age groups and is labeled, Not A Crime. 

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Now, another thing we found as a result of the study was that those in different age groups view insurance fraud very differently. While those 45 and older generally view insurance fraud as a crime, a large percentage of individuals between the ages of 18 and 44 do not because they don't believe they're personally affected by it. 

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Slide, Especially Those 45 & Under. On the left is a picture of a man and woman both holding their chins in thought. A bar graph is titled, If you know someone that committed insurance fraud, how did it make you feel? Envious or Motivated. The x-axis is the same age groups, and the y-axis is percentages from 0 to 30 in increments of 5. The three younger age groups are above 20% while the older groups are under 10%. 

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What's even more concerning with this age group is that 20 to 25% actually felt envious or motivated to commit insurance fraud after learning someone they knew committed it. And that should make all of us lose sleep because if someone is willing to lie, cheat and steal in their 20s, 30s and 40s, they're going to continue to lie as they get older. So the problem only stands to become far worse, especially if we don't take significant efforts to change the perception of the consumers in that demographic. 

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Slide, The Coalition Against Insurance Fraud. Text, Formed in 1993. Nearly 300 member organizations. Unites and empowers private & public groups to fight insurance fraud. A QR code is on the lower right. 

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And that's where my organization comes in. Formed over 30 years ago by 17 organizations representing consumers, insurers and government agencies, the Coalition Against Insurance Fraud is the nation's only alliance uniting diverse groups to fight insurance fraud through outreach, advocacy and research. 

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Slide, Diverse Groups United In The Fight Against Insurance Fraud. The QR code is still on the lower right. The Coalition Against Insurance Fraud logo, a circle of blue and yellow stripes, is enlarged in the middle of the slide. 

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Today, the Coalition is comprised of nearly 300 member organizations. And our diverse membership not only gives us a high degree of credibility with legislators, regulators, the media, the courts and the public, it allows us to initiate and support meaningful reform that protect both consumers and the insurance industry. 

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Slide, Thank You. A person sits at a table with a tablet in front of them and points at us.

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So now that we've talked a little bit about the escalating problem in cost of insurance fraud, I'm going to turn things over to Pranay to discuss how insurance fraud is evolving and Travelers' approach to fighting it. So, Pranay? 

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Slide, Guarding Against Fraud in the Digital Era. Insurance Fraud. Two categories of fraud with six photos each are titled Opportunistic and Organized. The Opportunistic pictures include Bodily Injury Fraud, a man smiles, Auto Physical Damage, a red car, Rate Evasion, a letter in the mail, Inflated Property Damage, a broken roof, Personal Property Values, a watch, and Faking Injuries, a woman tilts her neck. The Organized pictures include Practice of Medicine Fraud, a doctor writes a prescription, Unlawful Patient Referrals, a person does physical therapy, Medical Fraud, an x-ray, Auto Body Shop Fraud, a mechanic works on a car, Staged Losses, a car accident, and Contractor Fraud, a man builds a roof. Text, Copyright 2024, The Travelers Indemnity Company. All Rights Reserved. Logo, Travelers. 

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PRANAY MITTAL: Thank you so much, Michelle. So Michelle discussed insurance fraud at a high level. I thought I would begin today's discussion by just level-setting on how most carriers look at insurance fraud. 

And we think about fraud in two broad buckets. So when you think about-- the first one is opportunistic insurance fraud. And opportunistic insurance fraud occurs when someone knowingly submits a false claim or takes advantage of a legitimate claim by exaggerating facts.

Or, we could even have a potential policyholder who's misrepresenting the facts on an application form when they're buying a policy from us. And the examples for this could be-- so imagine that we have a property loss where an insured is exaggerating the value of the piece of expensive jewelry. We could have a claimant who's exaggerating the physical damage to the automobile.

Or we could have a claimant who's exaggerating bodily injury. A potential policyholder could be misstating the address of their automobile garaging location, just to get a lower rate. So the few examples I just mentioned, they are simple on the surface, but they're reported thousands of times a year. And so those are the examples for opportunistic fraud.

When you think about on the organized fraud, we have cases that involve multiple claims that are sophisticated, they're planned, and they're deliberate. And these are cases where we have medical providers, we have attorneys, we have property contracting companies, as well as auto body shops who could be intentionally committing fraud against us.

An example could be medical fraud, where you could have a medical provider who's submitting medical claims for services that were not needed or rendered. And this could involve completely faking patient records. You could have a property contractor fraud, where a contractor or a firm is intentionally misleading a client for the purposes of getting as much money as possible for subpar or incomplete work.

I think we all may have encountered roofing contractors. This is an example of fraud, when roofers are asking homeowners to replace their roofs when the roof is not even damaged, or there is no roof change that is needed. We also have auto body shops that sometimes engage in collision repair scams, ranging from inflated damage estimates or billing for repairs that were never done.

Now, at Travelers, we have numerous cases of both opportunistic and organized frauds that we investigate. And how do we investigate? Usually these investigations are done by our investigators. And what they do is they verify facts. And to investigate these cases, we do deep research in claim facts and policy facts.

We look at images. We look at surveillance videos. We look at all kinds of documents. We may even have recorded conversations with an insured. And based on all of that evidence, we determine the outcome of a case.

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Slide, Guarding Against Fraud in the Digital Era. Fraud is Evolving. Two photos. On the left, dark smoke billows out of a house's upstairs window. On the right, the back of a car is crashed in. 

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Now, next slide. So last year-- I wanted to share this quick story with all of you-- last year in November 2023, when I was working here at Travelers, I got a call from my home that my home was on fire, as you can see on the picture on the left. 

And on the way home, I had stopped at a light and was also rear-ended by another car. And so on the right-hand side, a picture of my car. I hope you all guessed it, but none of this is true.

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The photos change to a house not on fire and a car with no damage. 

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This is my house on the left, and this is my car on the right. Everything is fine. There is no fire, and there was no accident. 

All this was was simple image manipulation. We were able to doctor these images all in a matter of 15 minutes. Image manipulation involves the transformation or alteration of an image. In some image manipulations sometimes, you will hear them as skillful artwork, while other times, they are rather unethical, especially when they are used to deceive someone.

And with advancements in technology and AI, now we can create entire scenarios that are not true. And this image manipulation technology that I'm talking about has gotten so good that in many cases, it's difficult to detect with the naked eye. This challenge extends now beyond images into documents and other artifacts as well.

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Slide, Guarding Against Fraud in the Digital Era. Fraud is Evolving. On the left are three photos. The top is a red shed with a close-up on the window, which is damaged. The middle is a blue car with a close-up on a tire housing, which is cracked. The third is a sidewalk with a closeup on one part of the pavement, which is damp and cracked. In the middle is a form of an invoice from a mattress company. On the lower right is a form from a doctor office titled Premium Chiro, Notice of Emergency Medical Condition. On the top right is a bullet list. Text, Identity documents, medical bill, jewelry appraisal, towing bill, address proof, expense receipts, police reports, repair bill, prescription. 

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Next slide. 

On this slide, you will see some of the images and documents we-- have been created that are completely fake. All of these images have been generated using tools on the internet. If you just focus on the left-hand side, the images in the red blocks are the manipulated portions of these images.

The first image on the top left shows damage to a windowpane. The second image is showing damage to a vehicle. And the third is showing a crack on the floor. All of these are completely fake, generated in-house by us with tools on the internet.

And on the right, you will see a couple of examples of fake documents we have created in-house for the purposes of this discussion. The first one is a sales receipt, and the second document is a fake letter from a medical provider confirming an emergency medical condition of an injured patient.

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Slide, Guarding Against Fraud in the Digital Era. The Evolving Digital Fraud Industry. Text, The concept of fabricating digital artifacts expands beyond just documents and images. Pictures appear in circles labeled Videos, a security camera, Call masking, a cell phone, Location, a GPS, Images, a damaged car, Voice, a woman on the phone, Identity, Social Security cards, Dark Web, a person types in the dark, and Documents, a doctor fills out a form. 

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Now at Travelers, we have seen images that are downloaded from the internet that are submitted with claims. We've seen manipulated images where simple metadata changes have been made, like the date when the photo was taken. We've also seen license plates on automobile photos that have been changed. We've seen many, many different fake documents. We've seen fake jewelry appraisals. We've seen fake towing bills. We've even seen fake police reports.

The problem of sophisticated image manipulation and documents is only the beginning. There is an evolving digital fraud industry out there. And many of you are aware and have been hearing about the advancements in artificial intelligence, especially generative AI, over the last year and a half. 

Generative AI is a type of artificial intelligence that uses machine learning to create new content. And this content can include text, images, music, audio and videos. And there are many websites now on the internet that allow individuals to clone voices, manipulate videos, mask computer locations by manipulating IP addresses and also change caller IDs.

So while technology, of course, has many, many good uses, we do have to remember that that same technology is available to fraudsters on the web. As insurance companies look to move more of their processes online, fraudsters are looking for ways to take advantage of this technology to commit fraud.

So now imagine this scenario. A fraudster who's looking to commit fraud can first go onto the dark web. Just in case you are not familiar with the dark web, this is that part of the internet that's made up of hidden websites you can’t find through conventional web browsers.

So you'll need a special browser. But once you're in, it's not that difficult for you to buy some stolen data. This could be an individual's identity. You could get driver's licenses, Social Security numbers, passports, credit card information, online banking information, user ID and passwords of people, and a whole range of documents are also available.

So you could get that. And then you could create fake documents as needed. You could buy policies from an insurance company, or you could make up a claim. And these fraudsters now can be anywhere in the world because you can mask an IP address. They can call by changing their caller ID.

And they can manipulate or create fake voices, fake videos to make all of this happen. And this scenario that I'm talking about right now is not entirely fictitious because we've seen this kind of insurance fraud and have been able to catch it here at Travelers.

So when I was talking about opportunistic and organized fraud, imagine those same schemes, now those same schemes get a little bit more complicated because now we have technology aiding fraudsters to be able to fake documents, videos, images to commit fraud.

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Slide, Guarding Against Fraud in the Digital Era. Our Approach. Text, People. Analytics. Partnerships. 

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Let's move over a little bit and talk about our approach of fighting fraud here at Travelers. At Travelers, we think about our fight against insurance fraud in three broad buckets. It's people, it's analytics and then partnerships.

At Travelers, we fight fraud across all organizations, Underwriting as well as in Claim. And all our employees are trained and are aware of insurance fraud and know how to get these suspicious policies and claims to our SIU, which is the Specialized Investigative Unit at Travelers. And Travelers' SUI comprises of over 275 investigators who are distributed in strategic locations across the country who can detect any kind of fraud. 

Our SIU investigative capabilities at Travelers extend beyond traditional SIU capabilities you may see at any other carrier. At Travelers, we have specialized teams for debugging underwriting fraud. We have a team that specializes recovering stolen cargo. We have fire science experts that understand the cause and origin of fire.

We have organized fraud specialists. We have surveillance and alive and wellness check capabilities. And we also have special investigators that support our litigated cases. So that's our people aspect.

On the analytics side, we have many fraud fighting capabilities that help us with detection and investigation of fraud. Our predictive models run on our claims and identify which of our claims need additional investigation. And our investigators have a number of capabilities that allow us to investigate these cases faster. And as we think about the new digital fraud that we were talking about, Travelers has many capabilities today and a whole lot of new capabilities we are building that help us detect and investigate digital fraud.

And from a partnerships perspective, I think I'll just mention this. Our industry collaboration has always been one of our big strengths. We work with many different industry fraud-fighting groups to ensure we are aware of all these fraudsters that may be out there in the marketplace that have a history of fraud.

Our people leverage the trainings, the fraud alerts. They work with groups like the National Insurance Crime Bureau, NICB, as well as the Coalition Against Insurance Fraud, to fight fraud in the marketplace. And that is why I'm super excited here to be talking about this topic with Michelle. And with that, I'll turn it over to Jessica.

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The presentation slides end and the three speakers appear in a split screen. 

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JESSICA KEARNEY: Great. Thank you, Pranay, so much, and Michelle. That was a fantastic tee up to this conversation talking about what is fraud, what is it today. Those are some great examples that you both gave in terms of opportunistic fraud versus organized and some of the partnerships that we're going to need to lean on together to really raise awareness about this topic and do something about it. 

So I want to kick off the conversation, as we normally do here on Wednesdays with Woodward, to engage the audience a bit with a live poll, if we can pull up that live poll.

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The poll does not appear on screen. 

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So I know we've got a mixed audience here of folks from within the insurance industry and elsewhere. So I'm going to lean on the folks in the industry here who might touch some insurance claims to ask them, if you work with claims in the industry, what types of digitally altered fraudulent claims have you seen in the last 12 months? So all of those things that Michelle and Pranay just lined out, we want to get a sense for how many of these that we've actually, our audience, has actually been seeing out in the wild, if you will. 

So, responses are coming in. Let's go ahead and share the results. It looks like just under half, 44%, say they haven't seen any of these in the last 12 months. And then we've got quite a mix of others, 22% saying they've seen altered photos.

Forty percent saying they've seen altered documents, which I know we talked a little bit about in your presentation, Pranay. Video manipulation, 5%, voice cloning, 4%, fake medical evidence, 15%, stolen identities, 19%. Michelle, any initial reactions to what you're seeing here in the audience responses?

MICHELLE RAFELD: I'm actually surprised that not everybody has seen it and pleasantly surprised by that. But you know, what we're seeing with the altered documents especially-- that's one of the biggest topics out there today. When our members get together, they're always discussing lately best practices for verifying the authenticity of a document. Because as Pranay pointed out with his presentation, it's so easy to create something or even buy a document off the web to use to commit fraud.

JESSICA KEARNEY: Pranay, any thoughts on audience responses?

PRANAY MITTAL: Yeah, actually I thought we would probably get a response back of people seeing a lot more altered photos and documents. Because I personally feel-- I think there's a lot more altered documents that are being created, especially to Michelle's point. There are a lot of tools just that have popped up over the last, I would say, a year and a half, that allow you to really create fake pay stubs, fake medical bills, jewelry appraisals.

And honestly, there are places where you can go on the internet that, even if you do not want to use these websites to create them, you can actually just buy them. So I do think altered documents is definitely an issue.

And then, of course, altered photos definitely is also happening. And when you think about alteration of photos, there's an entire spectrum on how photos can be altered. There could be a simple manipulation that happens, or you could have someone using a tool like Photoshop to alter certain things in there.

Or you could use generative AI and completely create deepfakes. So there's a whole lot of things that's happening within the image realm right now.

MICHELLE RAFELD: And Jessica, if I may add one more point to this. In looking at these numbers a little bit more, I notice that only 19% have encountered stolen identities. And I want to point out that that is one of the No. 1 issues in the marketplace right now.

With what Pranay was touching on, there are fraudsters out there who are taking voice and video information that they find on social media. And they're manipulating that to be able to create-- they have the capability now to call into an insurance company using this technology and make it sound like they are the consumer.

And so they're asking to cash out their funds or transfer money to an account. And so I just wanted to take this opportunity to let the audience know that this is one of the No. 1 things out there that we're trying to deal with.

PRANAY MITTAL: Yeah, and just to add one more point, Michelle, to that. This stolen identity issue that you're talking about allows fraudsters to be a lot more global than how it was a few years ago. Because now, you can buy a stolen identity of somebody here in the United States, but the fraudster could not be physically here because you could mask your computer location. You could get around systems. You can change your caller ID when you're calling. All of this, because it's available, makes it a lot more easier for people outside the United States to be committing fraud against insurance companies.

JESSICA KEARNEY: All very scary stuff and an enlightening question, I think, as we're kind of seeing this real time with our audience, and they're up close with it. I want to take a moment because you both did such a nice job of setting up this topic.

Michelle, we mentioned your illustrious career in this industry. I want to take a moment and ask you to help put today in perspective. We're thinking back over your career. How does this moment feel to you?

MICHELLE RAFELD: Well, I have to say the landscape has undergone a complete transformation since I started in the industry. And it's been so fun to see it get more robust as the years go on.

I hate to admit this because I will no longer be able to fool anyone about my age, but when I began investigating insurance fraud, there was not one thing that was automated, and the internet did not exist.

At that time also, insurance claims were comprised of paper documents and physical photos, as well as videotapes and audio recordings. And so those suspicious claims that came into our investigative unit really did require true boots on the ground investigative work.

Also at that time, fraud detection systems were absolutely unheard of when I entered the field. And so really back then, the fraud landscape was solely a pay-and-chase environment, which it's not today. It's really been for me exciting to see the technology advancements over the years because so much now can be done to identify fraud, even before a policy is incepted or a claim is even made.

And it's really streamlined the investigation process overall. Investigative steps that once took us days or weeks to complete can now be done in a matter of minutes and with the click of a button, and all from someone's desk.

And I've got to tell you, it might be a little hard to believe for those of you who are not in the SIU world, but you can even conduct surveillance now from behind a computer. So it's pretty exciting. Now with that being said, the technology advancements have also been somewhat of what I would say or call a double-edged sword because individuals who are committing fraud have those same exact tools for use.

And so we're now again, as we mentioned, we're having to deal with very sophisticated criminals who are identifying and exploiting not only the insurers but consumers as well. And it's really resulting not only for insurers but law enforcement agencies to change their investigative staffing models to include technology experts.

Because a lot of the information and evidence that needs to be gathered, it's no longer there in physical form, and it requires a lot more work to get at it. So while technology's really been helpful in the investigative world for us, the complexities associated with it have also made the investigation process, as well as the prosecution process, just a little bit more difficult.

JESSICA KEARNEY: That's great. And very interesting point on staffing models and how we need to think about organizational responses moving forward. And Pranay, I kind of want to get you in on that question, too. I guess, what's been the most surprising to you as you've watched this evolution of insurance fraud over the recent years?

PRANAY MITTAL: You know, obviously I haven't been in the industry as long as Michelle has, and I've been here for a really short time. But I think what has really surprised me the most has been the pace of change, the pace of AI.

I was reading somewhere that ChatGPT, for example, has about 180 million users right now. And it took ChatGPT just about five days to add a million users to its user base after launching. And the ChatGPT, I think we all know, came out just like over a year back. And that currently gets about 1.7 billion visitors a month.

And just to put some things in perspective, it took Facebook about 10 months to reach 1 million users. Netflix took the longest of all, which took about 3 1/2 years to get to 1 million users. So the pace at which technology has been changing and the way it is getting adopted, I think that has been fascinating.

And I'll come back to why that is important from a fraud perspective. Even those images that I shared, I'll tell you we were testing this AI technology maybe nine months back, or maybe 10 months back. And the images that we were able to produce may not have been as realistic as the images that we were able to produce just 15 days back.

I think that pace at which this AI is changing and evolving and getting better and more realistic, I feel, has been one of the most exciting things as well, but also more surprising from a fraud perspective. Because what it does is it-- the same technology that is available for us to do a lot of things, a lot of really good things, from a productivity standpoint. The same technology now gets available to fraudsters as well.

And obviously, it's happening at the same time when insurance companies are trying to put more of their processes online. And so now you have the situation where processes are getting online, but fraudsters have this new technology, which they can use to exploit these processes.

You know that Michelle was talking about, for example, synthetic identity, or people stealing identities. I think that's a huge problem. I think we hear it-- every few days, I see something on the newspaper about identity fraud. It's become a lot more easier for people to completely fabricate someone's identity.

It's not only just go to the dark web and get somebody's identity. But then you fake the documents, and you fake the voice, and now you fake videos. And you completely create a scenario that is just totally untruthful.

And then I think the last point I'll make on this one, I feel globalization and cross-product fraud, I think the speed at which that has changed over the last couple of years because of technology, I think that's another thing that we don't, I feel, talk enough about.

But I do think at times, we've come across cases where you have people who are committing fraud, but they're just not in the United States. This is something that is very different from how it was, I would say, four or five years ago. But now, all of a sudden, you see a lot more because there are people who are getting access to this technology, and they can use it to exploit the systems that we have.

JESSICA KEARNEY: That's great. So I know we're getting a lot of questions in the chat about so what can we do about this, what are the tools that are available. And so I want to turn to you, Michelle. You talked about the Coalition and the broad range of activities that you undertake. Can you dig into that range of levers that you have at the Coalition with all the groups that you work with across industries? And in particular, could you comment on some of the regulatory efforts right now?

MICHELLE RAFELD: Yeah, I'd be happy to. As I mentioned earlier when I was talking about our organization, we really focus on advocacy, education and research to fight insurance fraud. And we are really actively advocating for legislation and policies that strengthen anti-fraud measures.

To give you an example, the Coalition’s currently urging state regulators, who are-- a lot of which are looking to adopt more robust consumer data privacy laws-- we're urging them to please build in a carve-out for fighting fraud because that data is so key to us in being able to detect potential fraud.

So we're working with them, as well as the NAIC, regularly, and providing comments to all the different working groups who are touching that area. And so we're going to continue to do that as we move forward and as other issues come about.

JESSICA KEARNEY: That's great. And Pranay, from your side, on the Travelers side, on the carrier side, what are you most excited about? Or what do you think holds the most promise in your view in terms of the ability to detect fraud today and maybe in the future?

PRANAY MITTAL: Yeah, I think I would say not only Travelers. I think all carriers now have algorithms in place that can identify suspicious claims. There are predictive models that run on claims that help teams identify which particular claims or policies we should be focusing on.

And then what happens is that once these models identify these claims, then investigators look at the claim facts, and there's a verification of documents, images, videos, medical bills, etc., things that happen.

So from a technology perspective, I feel here are a few things that I'm excited about. One is this whole image and text recognition technologies now that are available. They are enabling us to analyze documents, photos, unstructured data sources to detect fraudulent claims.

OCR helps us, or optical character recognition, it helps us extract text from documents. And while image recognition is allowing us to analyze photos for signs of manipulation, I think this is an exciting field of technology that I think carriers right now would be potentially interested in.

I think telematics, that's another one. In case of where carriers that have auto and property insurance, carriers can now use telematics and even IoT devices to collect real-time data on driving behaviors, on property conditions, environmental factors. And all of this just help us better assess risk and also detect fraudulent claims related to-- we were talking about staged accidents, property damage or theft.

But if I have to think about your question in terms of what holds the most promise, I think it's the combination of machine learning and artificial intelligence that holds the most promise in detecting fraud in the insurance industry.

And the reason I say that is because these technologies can continuously learn. And they adapt to the new fraud schemes. So it makes this combination of machine learning and AI highly effective in detecting both known as well as emerging types of fraud.

And the other one that I personally am super excited about is AI summarization. I think there's now just some newer technologies that allow videos to be summarized in text, or audios to be summarized in text. I think those kind of technologies hold a lot of promise for investigations in the future.

So it's not all bad. I know that we were talking about fraudsters having access to the technology. But then there's a lot of technology that is available for carriers as well for us to really boost up our detection capabilities as well as our investigation capabilities.

JESSICA KEARNEY: That's great. And Pranay, you started to touch on it there. I'd love to walk through the next few questions the life cycle, if you will, of a fraudulent claim. And I guess, Michelle, starting with you, can you help us identify, so at the very beginning, what types of individuals commit insurance fraud? We saw the broad range on your opening-- on both of your opening slides of the different types of fraud. Has the profile changed at all with fraud now in the digital era?

MICHELLE RAFELD: So the reality, Jessica, is anybody can commit insurance fraud. During my investigative career, we investigated consumers, contractors, insurance agents, company adjusters. You've got body shop owners engaging in fraud, caregivers, medical providers. One of my last cases at the department was an attorney who had submitted over $800,000 in fraudulent billings that were manipulated. And even members of organized crime rings, including the tech-savvy criminals from all across the globe.

So yeah, as we've mentioned several times, it really has changed. When I first started, it was really the consumer that I was dealing with. And then it got more into the employer fraud aspect of it, and then health care. And from there, it's just kind of taken off on its own, where everybody's gotten involved because it has become easier, as we've been talking about with not only the technology, but there's a--

I'm finding a lot more collusion out there, in terms of especially with these organized crime groups. These individuals from overseas that are engaging, this is organized crime at its finest. It's got the attention of not only federal authorities but global authorities. And it's calling for the partnership of those groups.

And it has even prompted the creation of a global insurance fraud summit that's starting to take place, where insurers who do business all over the world are partnering with investigative groups from all over the world to make those connections because we're now having to deal with not only criminals in our own countries, but other countries as well.

JESSICA KEARNEY: All right, so we've got the who defined, which is a pretty broad definition. But that's very helpful, especially walking through some of the history. And Pranay, can you, then, I guess, jog back to a fraudulent claim is submitted. What happens? What happens upon submission? Can you walk us through maybe what are the steps that it takes, and what kind of professionals and technology are increasingly involved?

PRANAY MITTAL: Yeah. So obviously, there are many different types of fraudulent claims. All these claims, they are on different lines of businesses. So we'll probably take a really simple example. Let's take a property claim as an example. Let's assume we get a property claim where we have, let's say, an insured that is claiming a loss of a Rolex watch.

And so the way it works is firstly when the claim comes in, our claim handler will verify the facts of the claim. They will try to understand how did this loss happen. Was there any documentation related to this Rolex? How old or new was this Rolex, for example?

And once all of this data is in the system, Jessica, to your question, you would have a predictive model that runs. And it could potentially flag that particular claim for any kind of missing documentation. Let's say there was no receipt that was submitted.

And once that happens, maybe now someone from SIU or somebody like an investigator would get involved, and they would look to verify facts. And those facts would be they would talk to the insured. They would see if there were any witnesses. They may also end up, for example, visiting the store from where that watch was purchased.

And depending on the facts of that claim, they'll collect those facts. They'll document those facts. And then they will send it back to the claim rep, who will make the decision about whether this claim needs to be paid, or it needs to be denied, or the payment amount needs to be adjusted.

Now along the way, there could be different technologies or publicly available data that could potentially an investigator may end up using to do some searches. But that's kind of the flow on what really happens when a claim comes in, right up to a time when an investigator tries to verify the facts.

JESSICA KEARNEY: And then, I guess taking it one step further from there, Michelle, what happens after an insurer investigates a claim and then refers it to the authorities for action? What's the process for actually holding individuals accountable for insurance fraud?

MICHELLE RAFELD: OK, so when a state fraud bureau or a law enforcement agency receives a referral, they're going to assess the allegation and request every bit of documentation that's associated with the claim and the investigation performed. And they do that to determine if there's sufficient evidence to pursue a case criminally.

Now, the agency will then conduct an independent investigation because they want to make sure they are able to reach the same conclusion as the carrier and then gather any additional evidence that might be needed to meet the "beyond a reasonable doubt" standard because carriers are somewhat limited in what they're able to obtain.

So if that standard can be met, then a criminal referral will be forwarded to a prosecuting agency. And then it's once again going to go through another various meticulous review process. And then if the prosecutor agrees that that reasonable doubt burden’s been met, then that's when criminal charges are initiated.

JESSICA KEARNEY: And so what are the repercussions for someone who is convicted of insurance fraud?

MICHELLE RAFELD: Individuals who commit insurance fraud really can find themselves facing some really serious legal and financial repercussions. And I have to say the specific consequences are going to vary. They're going to be based on the jurisdiction that's handling the case, the nature and severity of the fraudulent issue as well.

And so-- but with that being said, really what we see as being the most common repercussions are individuals then having a criminal record, and some even facing imprisonment. We see some individuals face lawsuits separate from the criminal proceedings that take place.

Many times the insurance carrier will go after them civilly, while the state will go after them criminally. And then you might have fines and penalties and restitutions that are ordered by the court. And that, again, could be from the criminal process or civil process.

One of the other things we see regularly is those individuals lose their insurance coverage, and then they've got difficulty obtaining insurance in the future. And if that individual is a professional, they may see professional consequences as well, such as the loss of a job or a professional license. Because no one wants to have a convicted felon on the books. And there's also a federal statute out there that says you have to get, especially if they're in the insurance industry at all, that says you've got to get a waiver to even be able to engage in the business of insurance.

You also have damage to someone's reputation and that can lead to increased scrutiny from law enforcement, as well as regulatory agencies. And then finally, the individual might face collateral damages, where they lose their eligibility to vote or own a firearm or even apply for government assistance programs. So it's pretty severe.

JESSICA KEARNEY: An important aspect of this, I guess not to lose sight of, and an important piece of that journey that we just outlined. And I want to go back to you, Pranay, picking up on that. We've talked a little bit about how investigations today look different than they have in the past. Can you dig into that a little bit more in terms of what that means for tools and resources and people, and how that shapes the organization that you run here at Travelers, for example?

PRANAY MITTAL: Yeah, well thank you, Jessica, for that question. See, I think it's important for all of us to just understand that fraud, as Michelle actually mentioned, that fraud has existed since insurance has existed. And the interesting thing about fraud is that it has always kept evolving. And as it has evolved, so has that fight for insurance fraud detection and investigation. That's just kept changing as well.

So I think Michelle said this. In the past, and I'd say in a lot of cases even now, a lot of the fraud investigations were dependent on physical inspections. So you would physically meet someone to make a statement. You would have to physically look at the car damage or a property damage. Or you're physically surveying an accident location. All of these things are important.

But in certain cases, now investigations in a group like SIU, now they have gotten a lot more digital. Let me give you a couple of examples of that. So for example, today you can download crash data from a car after an accident. So using data, you can determine the timing when the brakes were applied. You can determine the speed at impact. You can determine whether the driver was wearing a seat belt or not. You can also know whether the airbags, for example, were deployed or not.

Now imagine you know all of this exactly that happened before an accident, five seconds before that accident. All of this is very useful in a fraud investigation. So that's the digital aspect of what we can do with data.

Also, there's a lot of public data that's available right now, and a lot of the states are putting that data out there. For example, there are property records that are available. There are court records that are available. There's provider licensing information that is available. All of this can be used for investigation.

So over a period of time, Jessica, to answer your question, was a lot manual physical. And now we're moving into the world where it is still manual, but we're using a lot more tools and data available to do certain types of investigations. And I think the most important among all of this is fraud is a continuously evolving space.

And hence, there's a lot of emphasis that sometimes we don't talk about is on training. And our investigators are, for example, at Travelers, constantly we're working through trainings to make sure that we are aware of every new kind of emerging fraud that may be out there and then basically building those skills that are needed to be investigating that kind of fraud.

And that is why our partnerships are also really important. So whether it's Michelle's Coalition Against Insurance Fraud or the National Insurance Crime Bureau because sometimes these groups would end up hearing first about the fraud schemes. And they'll put out a training out there, and that's what we want our investigators to be able to taking so that they are equipped to handle any kind of new fraud that may be out there.

JESSICA KEARNEY: That's great. And I guess picking up on the line of thinking around education and training and awareness, we're getting lots of comments about that in the Q&A from the audience. We have a number of agents and brokers joining today's program and a number of questions coming in from them, so I want to spend a minute on this.

What advice would you both have specifically for insurance agents and brokers, kind of the front line, to stay vigilant against fraudulent claims?

PRANAY MITTAL: So Michelle, I can go first. In this new age of AI, I think the simple thing if I was to give somebody advice, I would say just remember that you want to trust, but you also want to verify. We have to remember that any identity documents or address proof documents or receipts or images or voice, all of it can be manipulated.

I think that is true from a business perspective. I think on a personal side as well, now when I get images, and people send me images from where they-- or holiday images, I sometimes even doubt those images because I know all these images can be manipulated really easily.

So we have to train our minds to be a lot more vigilant in our business as well as our personal lives. Because we may talk a lot and say, well, there's going to be a lot of technology to be able to detect deepfakes. But the truth of the matter is that that technology will be a step behind than the technology to make a deepfake.

And so I would say that even if we have all the technology tools available, I think it is really important for all of us, whether it's brokers, agents, folks who are working in Claim, or folks who are working in SIU, to be able to trust but verify everything on the onset. I think that's my one piece of advice.

MICHELLE RAFELD: Yeah, and I completely agree with you, Pranay. We were just on a call yesterday where we were talking about companies doing a little bit more two-party authentication and verification of who they're talking to, just asking maybe some information that they have in their systems that only the consumer would know.

And then we’re also-- some companies I've heard have actually, because the deepfake photos are so realistic, and it's somewhat hard to determine if they're fake or not, they're actually going back to old school, where it's boots on the ground, go verify. They're not going to accept that photo as a truth. They're going to go actually out and look at the vehicle to see if the damage exists.

So yeah, I totally agree with what you said about the added verification. I'd also like to point out, I think it's really important that insurance agents realize that they play a key role in the fight against fraud. Because at times, they are the first line of defense in the detection of it, especially when someone calls to make a claim, or someone comes in wanting to take out a policy, and some red flags go up.

And so I have always personally encouraged agents to listen to their gut instinct when that red flag does come up or they get that feeling that something just isn't right. I also have always encouraged agents who are in those situations to really ask questions and then document that information because that could later become key in a case.

And then finally you know I really want to stress the importance of reporting suspected fraud immediately. There is immunity associated with reporting. But the more an agent can do to report fraud, the carrier can then jump on that, investigate that matter, and then get it to the state department of insurance or law enforcement agency who has jurisdiction over it so they can take the appropriate action.

JESSICA KEARNEY: I want to follow that up, follow those comments up, with an audience question that we got in. And we actually have had several along these lines come in. How do you walk the fine line between protecting against insurance fraud and aggravating policyholders? I don't know who wants to take that, Pranay, Michelle, but I think that kind of hints around some of the point that you were just making.

PRANAY MITTAL: I can take it. See, walking that fine line, Jessica, between protecting against insurance fraud and maintaining a positive relationship with policyholders requires a very delicate balance and a proactive approach.

And it's not always easy to be able to do that. But some of the things that we try to emphasize is, for example, clear communication. So when we're meeting a policyholder, it's about clear communication that we are here to verify the facts.

We want to be as transparent as possible about the types of information and documentation we may require from policyholders up front. Clearly explain why certain information is necessary for us in the process. Also, we try to make sure that we have a streamlined process and we're not creating an inefficient process that could be burdensome to anyone whom we are trying to interact with.

And I think the other really important aspect about this is respect and empathy. So any interaction that we have with our policyholders, or claimants for that matter, it has to be done with a lot of respect and empathy. So within our group, we try to balance all of these things.

But it is not always easy, I would say, to walking that fine line between protecting against insurance fraud and aggravating policyholders. But I do think that you can draw that balance, as long as you're clear, your processes-- you're upfront, you're transparent, your processes are streamlined.

And then you're treating people with respect and empathy because a lot of people actually will work with you, once they understand the impact of insurance fraud and some of the things that Michelle was talking about and what it does to consumers, a lot of people whom we work with that are actually willing to work with us.

MICHELLE RAFELD: Yeah, and Pranay, if I could add on to that. One of the things that we always used to train investigators on-- and I know the industry does this as well-- is explain to the party that we're unbiased. We're the fact finders. We're just trying to get all the information that we can to make a decision or hear what fully happened with regard to that claim.

So I think that's also key in walking that fine line and letting the consumer know, or the individual know, that you're merely there getting the facts, and you're taking an unbiased look at it.

JESSICA KEARNEY: And I will flip that. I've got a few questions coming in from the audience. We talked about agents and brokers and how they can be a part of this process. We're also getting some questions about just everyday attendees as consumers. We have one person asking, should I not be vlogging or podcasting or using social media, knowing some of these things could-- Do you have any advice for folks just in their personal lives to protect themselves?

MICHELLE RAFELD: So, if you don't mind, I'll start with that, seeing as my former agency is a consumer protection agency. Yes. And I, too, am actually kind of getting away from social media a little bit because of the fears and what I've seen out there.

Protect your social media. Put the special permissions. Set those up in your account. If you get phone calls or emails, really think twice before looking at them or responding to them. Maybe if someone's calling you and something seems off, and they're asking you personal information, don't give any personal information over the phone.

And call that company back at a later date, just to see if it truly was a representative from the company. And I say that because as a regulator, we constantly were receiving phone calls that someone from an insurance company had called the consumer after a auto accident.

Well, guess what? That person calling wasn't from the insurance carrier. They had gotten the crash report. It noted who the consumer's insurance carrier was. And they were posing as the insurance carrier to lure them into using a body shop or a medical provider under false pretenses. So really question in this day and age what's going on.

And then two, take a look at your accounts. And I say that because of the identity theft issue that's out there right now. A lot of people don't monitor their accounts. In the life insurance and annuity space right now, identity theft is rampant. People are trying to get to those cash values in those products and policies.

And so they are trying to deceive the insurance carrier to cash those out. They're hacking people's emails. They are getting other information, key information that may help them get through the security protocols. And so really take a look at your accounts, keep up to date.

And look at any communications coming from your insurance carrier because some might actually be reaching out to say, hey, guess what. We're trying to verify that your address was just changed, and we want to make sure of that. That could be a huge red flag that your account's been compromised by a third party out there. So stay vigilant. There are identity protection services out there, so take advantage of them.

JESSICA KEARNEY: Michelle, in our final minute. What's on your agenda for the Coalition in 2024?

MICHELLE RAFELD: Oh, my gosh. We would need an entirely--

JESSICA KEARNEY: We'll schedule it.

MICHELLE RAFELD: --show to address that. But getting back to our research study that I talked about where consumer attitudes are changing, my No. 1 priority right now, I think, is for the Coalition and its members to make insurance fraud awareness its top priority in 2024 and really lead that charge to change consumer mindsets, especially under the age of 45.

On top of us looking to create consumer awareness messaging for all ages, what I want to do is really look to create educational programs and initiatives that are specifically geared towards high school and college students. My belief is if we take this approach, not only can we help the younger generations develop that ethical mindset that we need them to have, we can expose them to the world of insurance and help, hopefully, recognize that insurance fraud is a crime.

And also pique their interest maybe in pursuing a career in the industry because a lot of, I think, our younger generation have no idea what a key role our industry has in the global economy and just how exciting of a career path it could be if they're able to get in.

JESSICA KEARNEY: Wonderful. Well, I think that's a great note to end on. I want to thank you both, Michelle, Pranay, for a really fascinating conversation. I think we could have many more of these on this topic. But it's great to do the introduction and get some really useful information, so thank you both.

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