The New York State Insurance Fund has targeted workers’ compensation insurance fraud aggressively for years, but last year’s results rank with the best. Larry La Pointe and his team from the Francine James and Tom Gleason and the top brass on Church Street to the investigators and the rest of the NYSIF team deserve our thanks for 154 arrests in 2009 and $16.6 million in recoveries and estimated savings. That’s our money one way or the other. NYISF has its own division of Confidential Investigations (DCI) to detect and investigate suspected fraud committed by claimants as well as policyholders. Since 1995, NYSIF cases have accounted for 1,382 insurance fraud arrests, along with recoveries and estimated savings of $183.1 million. That’s a lot of fraud. Among anti-fraud special investigation units, NYSIF DCI ranks near the top nationally in annual arrests, and in cumulative fraud savings. NYSIF auditors have established a standard among insurance carriers for conducting premium audits that discourage improper payroll reporting and worker misclassification. “Our investigators, auditors and claims personnel train continually to recognize potential fraud,” NYSIF Director of Confidential Investigations Laurence LaPointe stated. “There are numbers of red flags built into our training to help us detect possible fraudulent activity by claimants, policyholders, or medical providers with whom we work.” Recent significant cases resulting in millions of dollars in savings to NYISF have included claimants who receive benefits while operating businesses or remain employed in other capacities, the most prevalent type of workers’ comp. fraud. Other cases involve premium fraud, the most costly type, in construction, asbestos abatement and other contracting, including investigations in conjunction with the U.S. Department of Labor, the U.S. Postal Inspector, and local labor racketeering bureaus. Still other cases involve fraudulent provider billing. NYSIF investigates only workers’ compensation and disability benefits fraud involving claimants, policyholders or medical providers who do business with NYSIF. Maybe they should consider renting out their top guns…NYSID Superintendent James W. Wrynn has named Martin A. Schwartzman to Deputy Superintendent for Strategic Planning and Market Initiatives, a new post to assist the Superintendent “make sure that New York remains a competitive insurance marketplace with choices for policyholders and an attractive place for insurers to conduct business,” according to the announcement which added: “Schwartzman will review agency procedures and processes and propose changes to ensure that the Department is as efficient and effective as possible. He will also study the Department’s structure to make sure that it fits the current state of the insurance market.” Deputy Supt. Schwartzman is a key player in the Department’s stellar line up and is currently playing an important role in developing reform proposals for med mal and title insurance. Previously Assistant Deputy Superintendent and Chief of the Life Bureau, responsible for supervising more than 500 life insurance companies, retirement systems, reinsurers, annuity funds and other entities, he served prior as Director of Policy Initiatives, Assistant Chief Examiner of the Department’s Property Bureau and Supervising Examiner with the Health Bureau. He has had much exposure at National Association of Insurance Commissioners (NAIC) on committees and has assisted the Superintendent on the Life Insurance and Annuities (A) Committee. Schwartzman was project coordinator for the New York State Medical Malpractice Taskforce and supervised the rate and form filings units of the Property Bureau. He was a key participant in developing and supervising the implementation of a risk-based examination program for the Health Bureau. A graduate of Hofstra University, he is a Certified Financial Examiner (CFE), Certified Insurance Examiner (CIE) and Chartered Property and Casualty Underwriter (CPCU) and was an instructor in Hofstra’s CPCU program for more than 10 years…We are pleased to include a rather passionate guest essay in this issue penned by Dr. Richard Amerling, M.D. on proposed Obama healthcare reform. The doctor asserts that ObamaCare, beyond the enormous costs and dislocations, directly inserts itself damagingly into the doctorpatient relationship. It will render portions of the Hippocratic oath undone, notably the key codicil: “I will prescribe regimen for the good of my patients according to my ability and my judgment. I will keep them from harm and injustice.” We think it’s a good angle, surely different from the pundits and politicos. In fact, we’d be interested in seeing what candidate Nan Hayworth, M.D. (running for Congress in what was Sue Kelly’s seat in the Hudson Valley) has to say in the debate, although at this writing it seems foregone that the administration and its allies will force feed their version of reform down our throats even as the economy is on life support and the jobs chart is plummeting downward.