June 9, 2024 • 15 mins
Original Air Date: June 9, 2024
Frank Sztuk is the Senior VP of Investigative Service at The Delta Group. Some of the latest fraud scams involves pain doctors.
Frank Sztuk is the Senior VP of Investigative Service at The Delta Group. Some of the latest fraud scams involves pain doctors.
Mark as Played
Transcript
Episode Transcript
Available transcripts are automatically generated. Complete accuracy is not guaranteed.
(00:00):
Welcome to Sunstein Sessions on iHeartRadio,Conversations about issues that matter. Here's your
host, three time Greasie Award winner, Shelley Sunstein joining me. A friend
of Sunstein Sunday, Frank Stooke.He is a senior vice president of Investigative
Service at the Delta Group and heis also a big part of the New
(00:25):
York Alliance Against Insurance Fraud. Andwe are again talking insurance fraud. And
the theme this period is that insurancefraud is like a tax on all of
us. Well, you know,I know people here insurance fraud. And
then a part of you your headgoes, oh, I'm tuning out.
(00:47):
This doesn't relate to me, butFrank, it does. It certainly relates
to everybody. Shelly, thank youso much for having me today. The
bottom line is when you look atwhen people look at taxes, it's something
you can't control. I mean,what's that old advantage? And nothing is
permanent in life except death and taxes. But insurance fraud is a tax that
(01:08):
we can control. And the realityof it is is it impacts everybody in
the state of New York, notjust the people paying for insurance, but
every person children, seniors, adults, teenagers, every person in the state
of New York, of coust I'mover nine hundred dollars a year to pay
(01:30):
for insurance fraud. And that's alot of money. And we're talking a
really wide spectrum. You know,people know about. I think some of
the insurance fraud, like when youfake an injury, or an employer will
categorize you improperly so they can savemoney when it comes to insurance. But
(01:56):
something that surprised me was that youhave to be aware if you're going to
a pain doctor, explain this withouta doubt. There's there are a number
Most doctors are honest and provide greatservice, but there are you know,
there's a small number of unscrupulous doctorswho will go after the system by over
(02:17):
prescribing medication, all right, becausethey get a kickback from that. They
have doctors who who provide treatment that'stotally unnecessary, doing surgeries on people that
don't need it, just to buildmedicare or build and build insurance companies,
you know. The and one ofthe main things is there's a lot of
(02:39):
doctors who will build your insurance companyfor services that they never even provided.
So I mean, that's one ofthe key ways for people to kind of
get ahead of this tax that we'retalking about this year, because everybody who
goes to a doctor, when youyou know, a few days maybe a
week later, you'll get it's knownas an explanation of benefits and EOB.
(03:02):
So what we're telling people with ourcampaign this year is simply make sure you
look at it and make sure thatyou take a look at the charges that
the doctors is billing for and wasa treatment that you received, was a
treatment that you got when you wentto the doctor's office, And that's that's
(03:23):
a big, big part of insurancefraud from a medical provider perspective. But
specifically the pain doctors were called out. So how do you know if you're
going to you know, when youfirst sign up for your first appointment,
what are some safeguards you can useto make sure that this doctor is legitimate.
(03:47):
Well, the first thing you wantto do is make sure that you
speak to your you know, yourgeneral care provider and get a reference to
a for lack of a better term, Shelley, a legitimate pain doctor,
all right, And the other thingthat that should be in the back of
your mind if you go to thisdoctor and the first thing that they do
(04:10):
at the end of the appointment isprovide you with with script for you know,
uh, numerous pain medications. Allright, that's not normal. So
you've got to you know, peoplehave to be wary of when they go
to that doctor. And then thesecond thing is how many times is this
(04:30):
doctor saying you have to now comeback to me next week, and the
week after and the week after,and every time they go it's the same
story. They spend a few minuteswith you and then you walk out with
a script for all this pain.You know, this this crazy pain medication.
Shelley, who is the biggest culpritwhen it comes to insurance fraud?
(04:56):
What's the bukest issue, the biggestissue we're seeing. Now, that's a
that's a tough question, Shelley,because there's a number of different things that
we're seeing. Workers compensation insurance fraudis rising, right, you mentioned it
in your opening, you know You'vegot and workers comp fraud takes a couple
different avenues. It's claiming fraud.It's people claiming they're injured on the job
(05:20):
when they weren't. It's lingering,people who are legitimately injured but want to
stay out of work longer and keepcollecting their work comp benefits. Then you
have the providers or the the employersthat you talked about before, who are
who are gaming the system by overyou know, understating their payroll, understating
(05:42):
the amount of employees that they haveon their on their payroll, under you
know, under reporting the types ofjobs that people do. And that's that's
one of the biggest things that we'reseeing now. But staged accidents is on
the rise again, Shelley, Peoplewho are out there, you know,
(06:02):
setting up accidents for the purpose ofmaking insurance claims. And you know,
we all all need to be verycareful now when we're out on the road,
and I mean, there's ways toavoid being a victim of a staged
accident. The biggest thing is,don't tailgate. Be aware of your surroundings,
(06:23):
don't you know. If you're tailgatingsomebody and that person is an accident
stager, they're gonna look in theirrear view mirror when they see you look
away, they're gonna slam on theirbrakes and then you're gonna hit them.
And the reality of it is ifyou hit somebody in the rear who's in
fall you are when in reality youwere the victim of staged accident. I
(06:48):
am speaking with Frank Stookey is asenior vice president of Investigative Services at the
Delta Group, and he is hehas been a leader for many, many
years in the New York Alliance AgainstInsurance Fraud. How does a spam phone
call connect with insurance fraud? Oh, that's that's a great one. That's
(07:13):
and if you remember, that's oneof our campaigns from a few years ago.
Cyber fraud is on the rise nowand what will happen is and unfortunately
it's people like me that are targetedseniors. Right, You'll get a phone
call and somebody will it'll sound likemaybe somebody you know, Hey, I'm
from Medicare. We just want tocheck your to make sure that your Medicare
(07:35):
information is up today? Can youprovide me with your Social Security number so
that I can go through these uh, these simple you know, procedures for
you just to make sure that you'reproperly covered. And the next thing,
you know, there's a lot ofpeople who will fall for that ruse.
They'll give up the information and thenthe next thing you know, the uh,
(07:59):
the the are hitting your insurance policy, or worse than that, they've
got information. Now they can getinto your bank accounts and empty empty your
savings just by answering a simple questionon a phone call. So bottom line
is, if you get a callfrom somebody you don't know, don't answer.
(08:20):
And if you do answer the phoneand they're asking you for personal information,
don't provide it. Tell them you'llget back to them, and then
call medicare or call your insurance companyand try to determine whether or not the
call was legitimate. And in mostcases, Shelley, it's not legitimate.
It's scammers trying to beat the system. And of course you get these texts
(08:43):
that look completely completely legitimate all thetime, Shelley. I got one this
morning on my business email, andmy name is so and so from such
and such a country. I'll leavethe names out. I'm in possess of
a thirty five million dollars that Iwould like to provide to you a portion
(09:05):
of that. All you need todo is click on a link below and
we'll arrange for the bank transfer andwe'll we'll return part of that money.
To you for your services. Happensevery day, Shelley, every day.
But that one is easy to seethrough. The ones I'm talking about are,
(09:26):
for example, the ones that youthink come from your bank, oh,
without a doubt. And there's there'ssome simple ways that you can tell
if it's legitimate. One of themvery simply is take your cursor and hover
over the email address, and it'llshow up. The actual email address that
that that that that message is comingfrom will then show up. It may
(09:48):
be written, you know, yourinsurance company dot com, but when you
hover over it, it shows theactual address, which is different. Well,
also, Shelley, look for misspellingand look look for words that are
out of place, look for badgrammar and things like that. But again
it's all too often, and unfortunately, Shelley, there's a lot of people
(10:11):
falling for these scams. What aboutthe role of AI, well, I
mean, a lot of it isunknown at this point five. A lot
of it is unknown. And youknow, the the interesting thing about AI,
(10:31):
Shelley, is that you know,those people who are really good at
it, they could recreate this conversationthat we're having just off a few spoken
words that you may have on oneof your shows or I may have on
this on this clip and it's it'salmost impossible to tell that it's AI generated.
(10:56):
For instance, one of the wehad a session and a comp it's
a few weeks ago and I andI asked the AI expert, is there
a way to look in the metadatato find out that it's AI generated?
And the answer is no, it'sit hasn't been developed yet. So from
an investigative standpoint, it's hard forus. I'm telling you, I've seen
(11:18):
things where you you can't tell thatit's a generated image or a generated video.
Well then how can the public protectourselves and what what sort of things
can we look for? Well,you know, very very simply as you
you know, it's and it's unfortunatethat you almost have to question everything you
see and you know things like youknow, we've we've talked in the past.
(11:43):
You think before you click, makesure that if you see yourself on
a video, did you did youdo that message? And if you didn't
call you can call the New YorkAlliance at A four four fraud and y
or you can go to our websiteat fraudandy dot com. Give us the
(12:03):
information and will report it for you, But you've got to be wary,
and you've and it's and literally andI'm going to repeat it, you almost
have to question everything we see.Now, going back to the fraudulent pain
doctors, should you call or checkonline with the Better Business Bureau before you
(12:26):
head to a doctor? Shelly,I'm not so sure that the Better Business
Bureau is going to give you theright information, all right, but you
can certainly check with the State MedicalBoard. You can go online to the
New York State Medical Board to checkon that doctor that you're going to.
Have they been disciplined, have theybeen convicted of illegal pain medication distribution?
(12:52):
All that information is there. Uh. And then the other thing that I
mentioned before, trust your own doctor. Check with your own doctor for a
referral to a to a a goodpain good pain clinic, if that's the
service that you need to obtain.See, I'm thinking that a lot of
people don't even go to regular doctorsanymore because the uh, you know,
(13:16):
the prices have gotten so high andthe and what's covered under insurance has been
cut and cut and cut. Sosomeone who's in pain is you know,
likely to see a billboard for example. And then get in touch. Well,
I mean people are even using eErs as their personal doctor, because
(13:37):
that is correct. Saw that withCOVID, you know. I I again,
I would direct people to go tothe state Medical Board to check on
those doctors and simply google the doctor'sname, you know, go to the
surface web and and and check upon that doctor and and do your own
(13:58):
research. Have they are there storiesabout that doctor having been involved in suspicious
activity? You'll find it on thesurface web. And if people have questions,
how can they reach out to youor the Alliance Against Insurance Fraud?
Okay? One of the things thatwe try to do every year is drive
(14:20):
activity to our website which is fraudand why dot com that's fraud? And
why dot com? Or call usdirectly at eight four four fraud and why
that's eight four four fraud? Andwhy? Okay, thank you so much,
Frank. I'm sure that we willbe checking in later in the year
(14:41):
on your latest campaign. And thanksfor being so making us so aware of
the many pitfalls that are out there. You've been listening to Sunstein sessions on
iHeartRadio. The production of New York'sclassic rockt Q one O four point three
Welcome to Sunstein Sessions on iHeartRadio,Conversations about issues that matter. Here's your
host, three time Greasie Award winner, Shelley Sunstein joining me. A friend
of Sunstein Sunday, Frank Stooke.He is a senior vice president of Investigative
Service at the Delta Group and heis also a big part of the New
(00:25):
York Alliance Against Insurance Fraud. Andwe are again talking insurance fraud. And
the theme this period is that insurancefraud is like a tax on all of
us. Well, you know,I know people here insurance fraud. And
then a part of you your headgoes, oh, I'm tuning out.
(00:47):
This doesn't relate to me, butFrank, it does. It certainly relates
to everybody. Shelly, thank youso much for having me today. The
bottom line is when you look atwhen people look at taxes, it's something
you can't control. I mean,what's that old advantage? And nothing is
permanent in life except death and taxes. But insurance fraud is a tax that
(01:08):
we can control. And the realityof it is is it impacts everybody in
the state of New York, notjust the people paying for insurance, but
every person children, seniors, adults, teenagers, every person in the state
of New York, of coust I'mover nine hundred dollars a year to pay
(01:30):
for insurance fraud. And that's alot of money. And we're talking a
really wide spectrum. You know,people know about. I think some of
the insurance fraud, like when youfake an injury, or an employer will
categorize you improperly so they can savemoney when it comes to insurance. But
(01:56):
something that surprised me was that youhave to be aware if you're going to
a pain doctor, explain this withouta doubt. There's there are a number
Most doctors are honest and provide greatservice, but there are you know,
there's a small number of unscrupulous doctorswho will go after the system by over
(02:17):
prescribing medication, all right, becausethey get a kickback from that. They
have doctors who who provide treatment that'stotally unnecessary, doing surgeries on people that
don't need it, just to buildmedicare or build and build insurance companies,
you know. The and one ofthe main things is there's a lot of
(02:39):
doctors who will build your insurance companyfor services that they never even provided.
So I mean, that's one ofthe key ways for people to kind of
get ahead of this tax that we'retalking about this year, because everybody who
goes to a doctor, when youyou know, a few days maybe a
week later, you'll get it's knownas an explanation of benefits and EOB.
(03:02):
So what we're telling people with ourcampaign this year is simply make sure you
look at it and make sure thatyou take a look at the charges that
the doctors is billing for and wasa treatment that you received, was a
treatment that you got when you wentto the doctor's office, And that's that's
(03:23):
a big, big part of insurancefraud from a medical provider perspective. But
specifically the pain doctors were called out. So how do you know if you're
going to you know, when youfirst sign up for your first appointment,
what are some safeguards you can useto make sure that this doctor is legitimate.
(03:47):
Well, the first thing you wantto do is make sure that you
speak to your you know, yourgeneral care provider and get a reference to
a for lack of a better term, Shelley, a legitimate pain doctor,
all right, And the other thingthat that should be in the back of
your mind if you go to thisdoctor and the first thing that they do
(04:10):
at the end of the appointment isprovide you with with script for you know,
uh, numerous pain medications. Allright, that's not normal. So
you've got to you know, peoplehave to be wary of when they go
to that doctor. And then thesecond thing is how many times is this
(04:30):
doctor saying you have to now comeback to me next week, and the
week after and the week after,and every time they go it's the same
story. They spend a few minuteswith you and then you walk out with
a script for all this pain.You know, this this crazy pain medication.
Shelley, who is the biggest culpritwhen it comes to insurance fraud?
(04:56):
What's the bukest issue, the biggestissue we're seeing. Now, that's a
that's a tough question, Shelley,because there's a number of different things that
we're seeing. Workers compensation insurance fraudis rising, right, you mentioned it
in your opening, you know You'vegot and workers comp fraud takes a couple
different avenues. It's claiming fraud.It's people claiming they're injured on the job
(05:20):
when they weren't. It's lingering,people who are legitimately injured but want to
stay out of work longer and keepcollecting their work comp benefits. Then you
have the providers or the the employersthat you talked about before, who are
who are gaming the system by overyou know, understating their payroll, understating
(05:42):
the amount of employees that they haveon their on their payroll, under you
know, under reporting the types ofjobs that people do. And that's that's
one of the biggest things that we'reseeing now. But staged accidents is on
the rise again, Shelley, Peoplewho are out there, you know,
(06:02):
setting up accidents for the purpose ofmaking insurance claims. And you know,
we all all need to be verycareful now when we're out on the road,
and I mean, there's ways toavoid being a victim of a staged
accident. The biggest thing is,don't tailgate. Be aware of your surroundings,
(06:23):
don't you know. If you're tailgatingsomebody and that person is an accident
stager, they're gonna look in theirrear view mirror when they see you look
away, they're gonna slam on theirbrakes and then you're gonna hit them.
And the reality of it is ifyou hit somebody in the rear who's in
fall you are when in reality youwere the victim of staged accident. I
(06:48):
am speaking with Frank Stookey is asenior vice president of Investigative Services at the
Delta Group, and he is hehas been a leader for many, many
years in the New York Alliance AgainstInsurance Fraud. How does a spam phone
call connect with insurance fraud? Oh, that's that's a great one. That's
(07:13):
and if you remember, that's oneof our campaigns from a few years ago.
Cyber fraud is on the rise nowand what will happen is and unfortunately
it's people like me that are targetedseniors. Right, You'll get a phone
call and somebody will it'll sound likemaybe somebody you know, Hey, I'm
from Medicare. We just want tocheck your to make sure that your Medicare
(07:35):
information is up today? Can youprovide me with your Social Security number so
that I can go through these uh, these simple you know, procedures for
you just to make sure that you'reproperly covered. And the next thing,
you know, there's a lot ofpeople who will fall for that ruse.
They'll give up the information and thenthe next thing you know, the uh,
(07:59):
the the are hitting your insurance policy, or worse than that, they've
got information. Now they can getinto your bank accounts and empty empty your
savings just by answering a simple questionon a phone call. So bottom line
is, if you get a callfrom somebody you don't know, don't answer.
(08:20):
And if you do answer the phoneand they're asking you for personal information,
don't provide it. Tell them you'llget back to them, and then
call medicare or call your insurance companyand try to determine whether or not the
call was legitimate. And in mostcases, Shelley, it's not legitimate.
It's scammers trying to beat the system. And of course you get these texts
(08:43):
that look completely completely legitimate all thetime, Shelley. I got one this
morning on my business email, andmy name is so and so from such
and such a country. I'll leavethe names out. I'm in possess of
a thirty five million dollars that Iwould like to provide to you a portion
(09:05):
of that. All you need todo is click on a link below and
we'll arrange for the bank transfer andwe'll we'll return part of that money.
To you for your services. Happensevery day, Shelley, every day.
But that one is easy to seethrough. The ones I'm talking about are,
(09:26):
for example, the ones that youthink come from your bank, oh,
without a doubt. And there's there'ssome simple ways that you can tell
if it's legitimate. One of themvery simply is take your cursor and hover
over the email address, and it'llshow up. The actual email address that
that that that that message is comingfrom will then show up. It may
(09:48):
be written, you know, yourinsurance company dot com, but when you
hover over it, it shows theactual address, which is different. Well,
also, Shelley, look for misspellingand look look for words that are
out of place, look for badgrammar and things like that. But again
it's all too often, and unfortunately, Shelley, there's a lot of people
(10:11):
falling for these scams. What aboutthe role of AI, well, I
mean, a lot of it isunknown at this point five. A lot
of it is unknown. And youknow, the the interesting thing about AI,
(10:31):
Shelley, is that you know,those people who are really good at
it, they could recreate this conversationthat we're having just off a few spoken
words that you may have on oneof your shows or I may have on
this on this clip and it's it'salmost impossible to tell that it's AI generated.
(10:56):
For instance, one of the wehad a session and a comp it's
a few weeks ago and I andI asked the AI expert, is there
a way to look in the metadatato find out that it's AI generated?
And the answer is no, it'sit hasn't been developed yet. So from
an investigative standpoint, it's hard forus. I'm telling you, I've seen
(11:18):
things where you you can't tell thatit's a generated image or a generated video.
Well then how can the public protectourselves and what what sort of things
can we look for? Well,you know, very very simply as you
you know, it's and it's unfortunatethat you almost have to question everything you
see and you know things like youknow, we've we've talked in the past.
(11:43):
You think before you click, makesure that if you see yourself on
a video, did you did youdo that message? And if you didn't
call you can call the New YorkAlliance at A four four fraud and y
or you can go to our websiteat fraudandy dot com. Give us the
(12:03):
information and will report it for you, But you've got to be wary,
and you've and it's and literally andI'm going to repeat it, you almost
have to question everything we see.Now, going back to the fraudulent pain
doctors, should you call or checkonline with the Better Business Bureau before you
(12:26):
head to a doctor? Shelly,I'm not so sure that the Better Business
Bureau is going to give you theright information, all right, but you
can certainly check with the State MedicalBoard. You can go online to the
New York State Medical Board to checkon that doctor that you're going to.
Have they been disciplined, have theybeen convicted of illegal pain medication distribution?
(12:52):
All that information is there. Uh. And then the other thing that I
mentioned before, trust your own doctor. Check with your own doctor for a
referral to a to a a goodpain good pain clinic, if that's the
service that you need to obtain.See, I'm thinking that a lot of
people don't even go to regular doctorsanymore because the uh, you know,
(13:16):
the prices have gotten so high andthe and what's covered under insurance has been
cut and cut and cut. Sosomeone who's in pain is you know,
likely to see a billboard for example. And then get in touch. Well,
I mean people are even using eErs as their personal doctor, because
(13:37):
that is correct. Saw that withCOVID, you know. I I again,
I would direct people to go tothe state Medical Board to check on
those doctors and simply google the doctor'sname, you know, go to the
surface web and and and check upon that doctor and and do your own
(13:58):
research. Have they are there storiesabout that doctor having been involved in suspicious
activity? You'll find it on thesurface web. And if people have questions,
how can they reach out to youor the Alliance Against Insurance Fraud?
Okay? One of the things thatwe try to do every year is drive
(14:20):
activity to our website which is fraudand why dot com that's fraud? And
why dot com? Or call usdirectly at eight four four fraud and why
that's eight four four fraud? Andwhy? Okay, thank you so much,
Frank. I'm sure that we willbe checking in later in the year
(14:41):
on your latest campaign. And thanksfor being so making us so aware of
the many pitfalls that are out there. You've been listening to Sunstein sessions on
iHeartRadio. The production of New York'sclassic rockt Q one O four point three
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