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Fraud Unit - Has Anyone Ever Reviewed Their Decisions? How to get the Fraud Unit to give evidence

#1 User is offline   Warren Forster 

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Posted 21 February 2007 - 04:11 PM

Hi All,

I am working flat out on a couple of cases whereby the Fraud Unit appears to have made decisions, but rather than provide information and give evidence, ACC and DRSL have decided to go ahead and get the matter reviewed with just the branch staff available.

This means that the branch staff will turn up and state that no decision was made, and therefore it will appear that no decision was made and therefore the reviewer will find that there is no jurisdiction.

Has anyone been sucessful in this ever before?

Cheers

Warren
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#2 User is offline   Alan Thomas 

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Posted 21 February 2007 - 05:29 PM

Warren

The fraud unit runs as a separate division from the main body of the ACC. They prefer not to let one hand know what the other hand is doing.

You will find that the fraud unit had no interest in reading the file and tried to create a complete new set of documents for the purposes of confirming a fraud hypothesis. Fraud staff receive no training in ACC legislation.

The INFORME program, the case manager's manual, has a checklist of questions and if there are enough ticks the case manager is allowed to turn the file over to the fraud unit. Typically the questions are like those the person have relatives are also on ACC, as this person being on ACC before, as this person change doctors to many times or not enough times, is this person taking too long to get better and so forth.

The Corporation is able to make a decision to cancel entitlements or even the claim and withhold the information that used to make the decision under the privacy act while they decide whether or not to go for a criminal prosecution. This creates a problem at review hearing level because there is no information to be reviewed. This does not stop the ACC however in this is why the ACC and DRSL are attempting to respond to a Review Hearing application without information.

Make a direct request for the "fraud file". Write a letter withdrawing all access to private information by any other agency including private investigators and ask for all of this information gathered thus far to be surrendered immediately. The reply will indicate whether or not a fraud file exists. If they do not surrender the fraud file it means that there is an act of fraud investigation.

As the ACC would have us believe that New Zealanders are five times more likely to commit medical insurance fraud (ACC fraud) then our counterparts in America, Canada, Australia, Britain etc it would be reasonable to assume that the ACC allegations of fraud are based on wrong or ill-conceived notions of dishonesty.

The best way to bring a fraud investigation to an abrupt halt is to do a complete information dump on the ACC in regards to every aspect of one's life whether the information be related to the ACC or not. It may pay to have the information project for reconstruction into a fraud allegation.

Obviously it is not in the ACC's interest to allow a Review Hearing to go ahead while they are mounting a fraud investigation for purposes of prosecution. Naturally they will try to pull the rug from underneath part 5 of the Act so as to create a criminal conviction as the evidence to the end entitlements rather than medical evidence as intended by the legislators.

The technique the fraud unit rely upon is inference and innuendo in very large volumes while at the same time doing their utmost to chase any evidence such as witnesses away by making threats. Private investigators have been known to call themselves detectives which is of course the legal. Private investigators tried to obtain search warrants so as to see is all evidence from both points of view and keep any evidence speaking against their hypothesis out of the court room by not returning it within three months.

Generally speaking most claimants being accused of fraud had no idea whether or not they have committed fraud. The result is that everybody, including legal counsel, run a mile leaving their poor mark high and dry without anybody to provide any assistance after the sheer terror.
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#3 User is offline   Alan Thomas 

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  Posted 21 February 2007 - 07:02 PM

A decision is identified by a cause and effect. In other words the ACC don't need to put their decision in writing. For example if your earnings compensation simply stopped and they prosecuted for fraud that would be a decision that you are no longer entitled earnings compensation. Justification for an action in itself is not necessarily the decision. But only the reason for the decision.

Of course the fraud unit is very well aware that if they produce a document for pecuniary advantage to the ACC based on unsubstantiated information they themselves have produced a fraudulent document and therefore are very unwilling to produce a paper trial to their decision. Generally they "encourage" case managers to make a decision.

I guess we will be watching this space waiting for ACC staff to be putting their neck in the noose.
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#4 User is offline   BLURB 

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Posted 14 March 2007 - 05:03 PM

:D
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