Due Diligence by Investigators

Expand your understanding of the deal by looking at your target from a different viewpoint

Steady pace of deals foreseen

A new year and predictions come out like snowflakes in January.  The mergers and acquisitions crowd is no different.  A recent poll in published in M&A magazine sponsored by KPMG predicted a “solid” 2014 as far as deal activity was concerned.  The poll asked the respondents several questions related to what they felt were critical drivers for deal creation and deal success in the coming year.  One of the items that kept popping up was the value of having solid Due Diligence as part of the deal.    

Define what you mean

Due Diligence can mean a lot of things depending upon who you ask as the concept can be applied across disciplines.  Accounting comes to mind.  As does finance and banking.  Several firms claim to have the right mix of research that covers all angles.  While this may be true, many other qualified outfits are out there who are specialized in specific types of research they can contribute to the overall research of the deal.  And because not all deals are the same, picking and choosing the right vendor to supply you with the information needed should be part of overall Due Diligence strategy.

Breaking down Due Diligence

For certain, CSI is not an accounting firm, nor do we possess the skill set required to analyze financial statements, investments and tax returns.  But we do offer something that enhances the overall value of Due Diligence. Investigative Research can cover a lot of ground but to simplify, the basic services are background checks and asset identification.  These items are not always considered as part of the Due Diligence equation but adding them can certainly fill critical gaps.  This information provides necessary insight into the business, its principles and their private and public lives.  And while not all bad information leads to a deal breaking apart, it certainly puts the deal makers in a better position to make decisions.

See your target in a different light

gideongartner.com

Public record research coupled with social media investigations have helped many clients understand the types of people they may be working with as deals unfold.  This information can apply to cultural integration of two merging companies to ensuring critical personnel are leading the type of lifestyle befitting their employment. Further, identification of assets held by company owners may go a long way to explaining balance sheet anomalies.

But merely gathering this information into a report is not enough.  If this research is part of a Due Diligence plan, it is important that the information gathered is organized and presented in a context that demonstrates an understanding that goes beyond the regurgitation of mere fact.  If the output ends up being confusing and imprecise, then that hinders the deal maker’s ability focus on the deal and mitigates the value of the research. Not good.

Focus on the deal; trust the research to the experts

If considering expanding the reach of Due Diligence research beyond financial statements, consider the following:

1. Even though there is a vast amount of information on the internet, don’t fool yourself into thinking you are capable of conducting background and social media research on your own.  Just because information is out there does not make you an investigator who knows ins and outs of the craft.  
2. Research into someone’s background can be quite extensive.  Set parameters with your researcher prior to engaging these services to ensure a focused outcome.
3. While you may have parameters set, investigative research may reveal leads which you may find worthy of exploring further.  If these arise, take additional time to consider expanding the research if the outcomes may be beneficial.    
4. Seek out a researcher with experience with M&A. Knowing the language of the deal makes explaining your needs that much easier. 
5. Demand a report that fits your needs.  If you want more information, less information, a summary, analysis or recommendations, ask for it.   

Disability Event Horizion

Communicate changes that impact your client as part of your anti-fraud protocols  

NY’s Finest Scammers 

It was recently reported that New York City Police and Firefighters were caught defrauding Social Security Disability Insurance benefits.  The disabilities being claimed were psychological in nature and many blamed the trauma they suffered was a result of the September 11 terrorist attacks. Several claims were investigated and 106 people were found to be involved in the scheme.

http://ehstoday.com/

The claimant’s were caught through the use of traditional surveillance and through observation of their social media posts.  The information gathered through these channels revealed their claims were not only invalid but also potentially fraudulent.   This allowed the investigators to deny the benefits and to charge the group with various levels of larceny.

A vulnerable system

Private disability carriers who have full time Special Investigation Units and ongoing anti-fraud training are typically well prepared to ferret out these scams. As for the SSDI, the Office of Inspector General is charged with protecting these funds.  But because the program is so large, it is hard to police.  Hearing about a scam that was discovered involving the SSDI fund is not that common.  Because it is hard to protect, the fund is vulnerable to fraud by the unscrupulous; including organized criminals.

In this case, it was clear that coordination was a part of the formula to defraud.  Leading this scam were a group of “advisors” who directed the claimant’s behaviors in an attempt to make their bogus claims believable. These “coaches” received kickbacks from the claimants in exchange for their advice. This strategic configuration to illicitly harvest funds from the trust fund is by definition organized crime.

What brought this case together though, was the cooperation between the Office of Inspector General, the NY district attorney’s office and their relationship with police and fire internal affairs. What forced this alliance was the exploitation of an event (9/11) and the PTSD it caused.  Or in this case, allegedly caused.

It’s different when businesses protect money

Private disability carriers also utilize surveillance and social media research to identify claimant behaviors that might be incongruent with their limitations and restrictions.  While these tools are powerful, it is the keen observation of the claim manager that is critical to the discovery of red flag indicators in a claim.  

Claim managers have the most intimate contact with the file and the claimant during the life cycle of the claim. As such, it stands to reason that they must receive comprehensive and consistent anti-fraud training to ensure suspect claims are identified.  However, for good anti-fraud efforts to work, it is  important that these critical employees see the bigger picture.

Flow of information is key

While private disability carriers or self-insured’s might not experience a scam as large as the one identified in New York, the potential exists for several claims to be filed related to a specific event experienced by a client- akin to the mass PTSD claims caused by 9/11.  

When these changes or events become apparent, it should be top of mind for claim professionals to communicate this information throughout their organization, especially to claim managers who are on the ground floor.  For instance, if a client announces that a plant is closing, the claim managers should be made aware of this as employees might file disingenuous claims in an attempt to extend income during a layoff.

Turn information into wisdom

Keeping a keen eye out for events that impact businesses you insure is a wise and healthy thing to do.  But keep in mind this information is not just useful to those in upper management.  Recognize how important this type of information could be to your front line employees.  In summary, keep in mind the following tips:

1. Anti-Fraud training should include fostering awareness of the client’s business situation.  
2. Claim managers need to be made aware of the changes to client’s status so that they can react appropriately to claims.
3. Claim Directors and above need to take it upon themselves to not only inform the claim managers of a change or significant event a client experienced but also demonstrate what that change might mean to claims and claim operations.
4. Be aware that weaknesses caused by changes my be exploited by coordinated efforts.
5. Know that incentives for third parties can influence claimant behavior.  

Don’t have an SIU?  Contact CSI for professional claim investigations and anti-fraud training.