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Author: Barry Zalma
Publisher:
ISBN:
Category : Business & Economics
Languages : en
Pages : 290
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Book Description
The state of California compels all who are even tangentially involved in the claims process to comply with and have training in the Fair Claims Practices Regulations (Regulations) and the Integral Anti-Fraud Personnel Regulations (SIU Regulations). It is necessary that those insurance agents and other persons who are engaged in any way in the presentation, processing or negotiation of insurance claims in the state of California be familiar with Regulations imposed by the state of California on all insurers doing business in the state. This book and its appendices will enable insurers to effect compliance with the Regulations when training or assisting claims personnel in their obligations to read and understand the Regulations. The Appendices include an outline for an insurance company staff member, trainer, or lawyer to use in conducting a training class to all of the insurer's integral anti-fraud personnel. Zalma provides insurers and their staff the information needed to comply with California SIU Regulations and the tools to train others to do the same.
Author: Barry Zalma
Publisher:
ISBN:
Category : Business & Economics
Languages : en
Pages : 290
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Book Description
The state of California compels all who are even tangentially involved in the claims process to comply with and have training in the Fair Claims Practices Regulations (Regulations) and the Integral Anti-Fraud Personnel Regulations (SIU Regulations). It is necessary that those insurance agents and other persons who are engaged in any way in the presentation, processing or negotiation of insurance claims in the state of California be familiar with Regulations imposed by the state of California on all insurers doing business in the state. This book and its appendices will enable insurers to effect compliance with the Regulations when training or assisting claims personnel in their obligations to read and understand the Regulations. The Appendices include an outline for an insurance company staff member, trainer, or lawyer to use in conducting a training class to all of the insurer's integral anti-fraud personnel. Zalma provides insurers and their staff the information needed to comply with California SIU Regulations and the tools to train others to do the same.
Author: California (State).
Publisher:
ISBN:
Category : Law
Languages : en
Pages : 116
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Book Description
Received document entitled: APPLICATION FOR LEAVE TO FILE EXHIBITS
Author: Barry Zalma
Publisher:
ISBN: 9781980431732
Category :
Languages : en
Pages : 204
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Book Description
This book was designed to assist insurance personnel who do business in the state of California. It will assist all insurance claims personnel, claims professionals, independent insurance adjusters, special fraud investigators, private investigators who work for the insurance industry, the management in the industry, the attorneys who serve the industry, public insurance adjusters, policyholders and counsel for policyholders working with insurers doing business in California. All insurers doing business in California must comply with the requirements of the Regulations or face the ire of, and attempts at financial punishment from, the CDOI. That punishment is now questionable and limited because some courageous insurers fought the CDOI and succeeded before an administrative law judge who limited the right to punish. Regardless of difficulties in assessing punishment the state of California requires all who are involved in the claims process -- even if only tangentially -- to be trained with regard claims handling in compliance with the Regulations and attest to completion of such training under oath. To avoid the annual training the claims person can submit a sworn document that avers that he or she has read and understood the Regulations. Reviewing this book and the Regulations set forth below should be sufficient to comply with the training requirements of the Regulations.It is necessary that insurance personnel who are engaged in any way in the presentation, processing, or negotiation of insurance claims in California be familiar with the Regulations. Counsel for insurers and policyholders should also be familiar with the Regulations since they set a minimum standard for claims handling in the state.
Author: United States. Congress. House. Committee on Merchant Marine and Fisheries. Subcommittee on Coast Guard and Navigation
Publisher:
ISBN:
Category : Fire prevention
Languages : en
Pages : 890
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Book Description
Author:
Publisher:
ISBN:
Category : Administrative agencies
Languages : en
Pages : 654
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Book Description
Author: Malcolm K Sparrow
Publisher: Basic Books
ISBN: 0465010741
Category : Political Science
Languages : en
Pages : 306
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Book Description
Who steals? An extraordinary range of folk -- from low-life hoods who sign on as Medicare or Medicaid providers equipped with nothing more than beepers and mailboxes, to drug trafficking organizations, organized crime syndicates, and even major hospital chains. In License to Steal, Malcolm K. Sparrow shows how the industry's defenses, which focus mostly on finding and correcting billing errors, are no match for such well orchestrated attacks. The maxim for thieves simply becomes "bill your lies correctly." Provided they do that, fraud perpetrators with any degree of sophistication can steal millions of dollars with impunity, testing payment systems carefully, and then spreading fraudulent billings widely enough across patient and provider accounts to escape detection. The kinds of highly automated, quality controlled claims processing systems that pervade the industry present fraud perpetrators with their favorite kind of target: rich, fast paying, transparent, utterly predictable check printing systems, with little threat of human intervention, and with the U.S. Treasury on the end of the electronic line. Sparrow picks apart the industry's response to the government's efforts to control this problem. The provider associations (well heeled and politically influential) have vociferously opposed almost every recent enforcement initiative, creating the unfortunate public impression that the entire health care industry is against effective fraud control. A significant segment of the industry, it seems, regards fraud and abuse not as a problem, but as a lucrative enterprise worth defending. Meanwhile, it remains a perfectly commonplace experience for patients or their relatives to examine a medical bill and discover that half of it never happened, or that; likewise, if patients then complain, they discover that no one seems to care, or that no one has the resources to do anything about it. Sparrow's research suggests that the growth of capitated managed care systems does not solve the problem, as many in the industry had assumed, but merely changes its form. The managed care environment produces scams involving underutilization, and the withholding of medical care schemes that are harder to uncover and investigate, and much more dangerous to human health. Having worked extensively with federal and state officials since the appearance of his first book on this subject, Sparrow is in a unique position to evaluate recent law enforcement initiatives. He admits the "war on fraud" is at least now engaged, but it is far from won.
Author: California. Department of Insurance
Publisher:
ISBN:
Category : Insurance
Languages : en
Pages : 316
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Book Description
Author: Frederick T. Short
Publisher: Univ of California Press
ISBN: 9780520240476
Category : Nature
Languages : en
Pages : 336
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Book Description
Seagrasses are a vital and widespread but often overlooked coastal marine habitat. This volume provides a global survey of their distribution and conservation status.
Author:
Publisher:
ISBN:
Category : Administrative law
Languages : en
Pages : 544
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Book Description
Author:
Publisher:
ISBN:
Category : Administrative law
Languages : en
Pages : 556
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Book Description
The Code of Federal Regulations is the codification of the general and permanent rules published in the Federal Register by the executive departments and agencies of the Federal Government.
