Industry stalwarts Karen Smyth (Vice President of Long Term Care Operations at Wilton Re) and Jeff Ferrand (Vice President of Fraud Services at LTCG) have significant experience developing and implementing anti-fraud, waste, and abuse programs at the carrier and TPA level.
Please listen to the below podcast with Chris Petillo and Jessica Loesing as they discuss Karen’s and Jeff’s views on, among other questions, how fraud, waste, and abuse manifest in the LTCi space, and potential efforts carriers and TPAs can use to prevent and detect fraud, waste, and abuse. Karen also shares her experience as a witness in a criminal trial involving LTCi insurance fraud and Jeff shares his past experience as outside counsel prosecuting insurance fraud cases. Finally, stick around to hear some of the creative and industrious ways Karen and Jeff have been passing the time with their families (at home) during the pandemic.
* This podcast references the Dallal litigation pending in the Federal District Court for the Central District of California (Case No. 16-cv-9307). The podcast was recorded days before the November 13, 2020 decision in that case holding, inter alia, that an LTCi insurance policy can be voided under California law based on fraudulent claims for benefits submitted over a 12-year period. See — F.Supp.3d —, 2020 WL 6797531, at **24-26.
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Thanks, Chris and Jess for the opportunity to allow Jeff and me to share our views about fraud, waste and abuse in the long term care insurance industry. We hope others find value in the points we made in the podcast – we really enjoyed the discussion!
Thank you, Karen! We certainly enjoyed the conversation and appreciated yours and Jeff’s insights!
Great job Jeff and Karen. A lot of really great points. I really liked Jeff’s point about how the best investigators are the ones that give the benefit of the doubt and treat the PH/Family/Caregiver as a human. Being able to gather the facts while still treating them like they are human I feel like is really important. Coming from a Claim Exam perspective we see a lot of instances where people just need further education.