Using Analytics, Cloud, and AI to address fraud in Worker’s Compensation Insurance and Healthcare industry.

Insurance fraud is one of America's largest crimes — at least $80billion is stolen each year.In 2011, $2.27 trillion was spent on health care and more than four billion health insurance claims were processed in the United States. It is an undisputed reality that some of these health insurance claims are fraudulent. Although they constitute only a small fraction, those fraudulent claims carry a very high price tag. With rising insurance and healthcare costs, the fraud in workers compensation insurance, and health care is also getting out of control.

Use of modern technology previously unavailable makes it possible to identify suspicious behavior, quantify and address even complex cases of fraud possible with considerable ease and affordable costs.

During the past 28 years, Mr. King’s workers’ compensation fraud investigations have resulted in more than 800 criminal prosecutions in 23 states, including the first criminal prosecution for workers’ compensation fraud in a number of states. Mr. King’s SIU Team results received national recognition in numerous trade publications including the Journal of Commerce, National Underwriter, Business Insurance, and the California Workers’ Compensation Institute as being the leader in insurance fraud fighting efforts and identified the unit as the most proactive Special Investigative Unit in the nation. Mr. King chaired the State of California, Fraud Division SIU Training Committee that created the “Workers’ Compensation Insurance Special Investigations Unit Guidelines and Protocols” which has been the leading Workers’ Compensation SIU Training Resource in California for that past 16 years.