NICB Agents Receive Investigation of the Year Award

Courtesy: San Diego County DA

The National Health Care Anti-Fraud Association (NHCAA) recently presented its 2016 Investigation of the Year Award to NICB Supervisory Special Agent Tom Downey and Special Agent Malisa Trimble of the West Region. The Agents received the award for their “Operation Backlash” investigation, which resulted in the indictment of eight defendants in November of 2015, 13 defendants in January of 2016, and federal indictments against three individuals and four corporations.

“Operation Backlash” was an extensive 4-year multi-agency undercover operation initiated to combat entrenched corruption in the California Workers’ Compensation System (CWCS) private insurance program. The loss to CWCS was in excess of a half-billion dollars. The sheer scale of this fraud makes it one of the largest insurance bribery schemes in workers’ compensation ever uncovered in San Diego County.

The case aggressively targeted a vast web of multiple conspiracies involving doctors, attorneys, and chiropractors working with patient call centers, ancillary service providers, and medical marketers. The targets all paid and received several million dollars in illegal kickbacks.
To date, a total of 22 individuals and 10 corporations have been indicted and plea agreements have been secured with 6 individuals and 3 corporations tallying over $2.1 million in forfeitures. As a result of these actions, 13 criminal organizations have been disrupted and 3 criminal organizations have been dismantled.

SSA Tom Downey and SA Malisa Trimble with their NHCAA Investigation of the Year Award

NICB Blue – The First Female Agents: Part I

A few short weeks ago, the FBI commemorated the 40th anniversary of the first female agents serving in the field. We at the NICB would also like to pay tribute to four of our own female colleagues who are pioneers and have demonstrated excellence in their field as investigators. Over the next few weeks, we’ll be highlighting their stories as they provide insight into their experiences.

Sr. Special Agent Colleen C. (23 Years of Service)
Before joining NICB’s predecessor organization, the Insurance Crime Prevention Institute (ICPI), I was a local police officer. I was a patrol officer, photographer and identification officer (predecessor to CSI) and investigated sexual assaults. An agent from the National Auto Theft Bureau (NATB) came to teach my academy class about auto theft. I had actually heard of them before that because my father was a local police officer and had a knack for recovering stolen cars. I had majored in legal studies and received my masters in criminal justice while in the department. Prior to the police department, I worked for Family Planning. This helped me familiarize myself with medical forms and terminology which is now useful in medical investigations.

I saw ICPI as the good part of police work. I could investigate cases, but no one was bleeding on me, throwing up on me or threatening to kill me. I could be a detective and didn’t have to wear a bullet proof vest anymore.

The first ICPI meeting I went to, I looked around the room and realized I was the only woman there. I asked if the company had any women and was told there was one in Chicago. I was used to being one of a few women. My police department had three female officers. But my first agent’s meeting consisted of 75 men and me.

Women agents had to be very professional, always conscious of the image they were presenting. We had to remember that anything we did reflected on all the other women working with us. For a while, we formed the WNICB (Women of NICB), and I was honorary president. We would just meet for dinner when we found ourselves in the same part of the country. We had a lot of fun.

When I started, we had no computers. We kept paper case files, and we snail-mailed index cards to New York to the Property Insurance Loss Register (PILR) and Central Index Bureau (CIB ) to find out a subject’s claims history. I had a tour of the facility once. There were literally floors of giant rolodexes of index cards and lots of women running around in tennis shoes filing the cards. Our office had a teletype machine in it where we could check the Registry of Motor vehicles for stolen vehicles. We used typewriters back then and, in fact, I still have a NICB typewriter. We had so much paper. We all had storage issues. Eventually we got computers and dial up capability. I remember one agent from a rural area asking what you were supposed to do if the only phone was a “crank it up” phone.

All in all, we have come a long way in a relatively short time. We added the all claims database. Today we are mostly paperless, and we’ve gone from marveling at the addition of an exciting new dedicated fax machine plugged into a phone line to sending faxes from laptops using a wireless connection.  In addition, NICB’s image with the insurance carriers, law enforcement and the public has greatly improved. And we have improved their understanding of insurance fraud. When I first started, I brought a case to a police chief who told me it was a civil issue. I had to show him the law. In the beginning, there were no fraud bureaus. Often there were no laws against insurance fraud and no immunity statutes. Now, in my experience, juries don’t have any trouble comprehending the impact of insurance fraud, and they are oftentimes irate about the insurance fraud they see.

I have had some interesting cases. A postal inspector and I started the investigation that was later called “Plunderdome.” It was a body shop case that branched into public corruption. I had a staged accident ring case that had some links to terrorists. I have had cases that started with insurance fraud and included extortion, kidnapping, rape, murder, environmental violations, structuring, money laundering, tax evasion, arson, drugs, guns and prostitution. Witnesses and suspects have committed suicide, been murdered, gone to prison, returned to their native country, died of natural causes, and disappeared, presumed dead. I have been threatened a few times, subjected to veiled threats of violence, but more often threats of litigation. I have worked with law enforcement agencies at the local, state, federal and even international level. 

I have been with NICB almost 23 years now. Overall, it has been a good experience. I was able to travel a bit. I have met a lot of dedicated and talented people. We have accomplished a lot. Sometimes the job is frustrating. Unfortunately, not every case turns out the way we want it to. But we have had a lot of successes, too, and they make it all worthwhile.