Archives

15Jan 2020

An Interview with Jay Bobrowsky, SVP of Special Investigation

We recently sat down with Jay Bobrowsky, Senior Vice President of Special Investigation and asked him some questions about his role and recent cases.

Q. Can you please tell me about your background in the area of insurance fraud and investigation services?

A. I have a diverse background with more than 25 years of experience in insurance fraud and investigative services. Most recently I worked for Employers Insurance Company as manager of the Fraud Investigations department. I also worked for the Special Investigation Units (SIU) at Farmers, Esurance, Progressive and Liberty Mutual. I currently serve as the president of Anti-Fraud Alliance/NCFIA. I am very passionate about doing the “right thing” for our policyholders and California businesses.

Q. What do you see as the role of SIU here at State Fund?

A. We need to re-enforce an anti-fraud culture in what we do and partner with our employers and brokers to identify and investigate fraud within the system and aggressively go after and investigate any potential cases of fraud. Deterring, identifying and investigating fraud is core to our business, the state of California, and a vibrant economy.

Q. Can you tell me about some recent successful SIU cases?

A. Here are examples of two recent cases:

PREMIUM FRAUD

A fraud claim was filed with the El Dorado County District Attorney’s office against the owner of the company, for underreporting $245,974 in payroll from April 2013 to June 2016. The final underreported payroll amount was identified through bank warrants obtained by the CDI. A forensic audit for those years along with State Fund’s Billing & Collections department calculated a total premium loss of $30,957. In September 2019, the owner was convicted of a misdemeanor and paid the total restitution of $30,957 prior to sentencing, in order to get the charges reduced to a misdemeanor, and was given 36 months’ probation and a $2,500 fine.

PROVIDER FRAUD

In April 2017, the Santa Clara County District Attorney’s Office filed criminal charges against the owner of the company for the non-licensure of diagnostic imaging services.

In 2018, the owner entered into a settlement agreement with State Fund’s Corporate Legal, agreeing to pay $100,000 in restitution, and to release any and all outstanding bills and liens for State Fund’s injured workers up to and through June 2017. The owner paid the restitution in full to State Fund.

On August 2019, the owner pled no contest in Santa Clara County Superior Court to one misdemeanor count, concealing or failing to disclose an event affecting a right to an insurance benefit, specifically, failing to disclose non-licensure for diagnostic imaging services. Additionally, the owner was sentenced to probation, community service, fines and fees.

Q. What should a broker do if they suspect fraud on the part of their policyholder?

A. Get a hold of our SIU. To report suspected fraud to the SIU, use the Fraud Hotline: (888) 782-8338 from 7:30 AM – 5:30 pm, Monday – Friday, or send an email to SIUMailbox@scif.com.

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