Daniel L. Finnegan, PhD

President, Quality Planning Corporation

 

Dr. Finnegan is an applied statistician with nearly two decades of high-level professional experi­ence in the design and implementation of cost and fraud management systems. He has conducted over $70 million in re­search and development projects for cost and fraud control in the nation’s ma­jor private and public insurance pro­grams. Control sys­tems he has designed are cur­rently in use at over 10,000 locations worldwide and are producing doc­umented savings of more than $550 million annually.

 

Recent engagements to the private insurance industry in­clude:

 

Underwriting

 

• Re-engineered underwriting process for a major carrier to reduce rating error. Within three years total premium lost to rating error fell from over 10 percent to under 1 percent.
• Directed re-underwriting of over 250,000 auto policies producing savings in over $20,000,000 annually.
• Design and implementation of an automated re-underwriting system that identifies policy rating errors.
• Designed targeting system for workers’ compensation premium audits
• Participation in the development of the per­sonal auto actuarial database used by leading California carriers to create Propo­si­tion 103-man­dated rating plans.
• Database crosschecks to detect premium avoidance for WC policies.
• Developed an automated insurance application system that performed underwriting verifications during the application process.
• Developed monitoring system to control underwriting and rating errors by sales agents.
• Development of Compliance, an actuarial support soft­ware package.
• Keynote speaker for the National Association of Attorney Generals conference on insurance fraud.
• Development and training of a special investigation unit that targets organized fraud gangs.
• Development of an auto pre-inspection program.
• Financial audit of vehicle salvage operations.
• Development of a statistical targeting system provided early identification of claims likely to be fraudulent.
• Operational audits of motorist and motor vehicle licensing functions.
• Evaluated new and used part purchasing program.
• Built pattern analysis system for evaluation of medical bills for possible fraud.
• Assisted in setup of specialized claim unit for handling complex head trauma cases.
• Directed benchmarking study of comparative costs in body injury claims.
• Evaluation of telephone claims handling operations
• Keynote speaker for international conference on fraud control.
• Evaluation of experimental test of alternative medical programs for treating whiplash injuries.
• Installed and evaluated telephone scripting procedures to deter fraudulent claims before they occur.
• Developed and maintained automated new business rating audit program
• Benchmark analysis of time of disability periods for workers compensation.
• Fraud control training for over 700 adjusters and claims supervisors representing 55 insurance companies.
• Co-author of an adjusters’ manual on procedures for the identification and handling of fraudulent and exaggerated claims, adopted nationally by one of the nation’s largest carriers.
• Cost-benefit analysis of alternative methods of reviewing medical bills for fraud and exaggeration.
• Training adjusters to identify and resist claim fraud and exaggeration in auto BI medical bills.
• Development of standard claim letters and other communications designed to deter fraud.
• Development of the nation’s first fraud moni­toring system designed to track the type, number and distribution of potentially fraudu­lent claims.
• Programming and maintaining a database of health care providers sanctioned for fraud and misconduct by the federal government.
• Procedural reviews of sales and underwriting operations to identify methods for reducing rating factor misreporting and error.
• Training adjusters on procedures for the identification and control of potentially fraudulent worker’s compensation claims.
• Membership on the California DOI advisory panel preparing state anti-fraud regulations.
• Fraud vulnerability assessments in auto claims, worker’s compensation underwrit­ing, and per­sonal lines underwriting for three ma­jor national insur­ers.
• Technical support for the preparation of a state-mandated fraud plan.
• A resource budgeting workshop for claim man­agers, designed to optimize the alloca­tion of claim adjustment and investigation resources.
• Design of a training program for adjusters to recognize staged-accidents and other types of fraud.
• Cost-effectiveness analysis of a Special In­vestigation Unit.
• Conducting a national series of training seminars for senior insurance executives on fraud control.
• Analyze auto claim data and estimate potential savings from increased SIU investigations for a State Attorney General.
• Design and programming an auto underwriting system that verifies reported rating factors.
• Development of statistical WC claim reserving procedures
• Evaluated deterrence effects of fraud prosecutions.
• Cost-benefit analysis of use of private investigators.
• Fraud vulnerability analysis of claim payment system.
• Pattern analysis for detection of fraudulent collusion of adjusters and claims vendors.
• Evaluation of program to control bodily injury claim costs from minimum damage claims.
• Pattern analysis for detecting fraud in commercial auto claims.

Claims

 

Example Federal and State fraud control engagements:

• Member, national blue ribbon panel, for fraud control in Medicare and Medicaid
• Statistical support on error reduction for the Internal Revenue Service.
• Development of an artificial intelligence sys­tem to detect errors in Social Security Dis­ability Insurance benefit determinations. Simulations of the system anticipated initial savings of $120,000 a day, with increasing savings as the system “learns” from experi­ence.
• Statistical support for the national Food Stamp/Medicaid/AFDC Integrated Quality Control System, the Federal government’s major fraud monitoring system in the social insurance programs.
• Design and evaluation of the financial man­age­ment systems for the $27 billion Guaran­teed Student Loan Program to prevent loan defaults and to collect de­faulted loans.
• Design of a quality assurance system to re­duce fraud, waste, and abuse in the $5.5 bil­lion a year School Meals Program. Adop­tion of the pro­ject’s recommendations have resulted in savings to the government of over $150 million a year.
• National audit samples of over 4,000 recipients of the WIC Nutrition and TEFAP Programs.
• Design and implementation of the National Food Stamp Fraud Control Store Monitoring System.
• Cost-benefit analysis of 150 alternative com­puterized welfare fraud control systems.
• National training for State Fraud Monitors for federal health and nutrition programs.
• Development of background check and credit underwriting procedures to minimize defaults in Small Business Administration pro­grams.
• Development of audit and program review manuals for the Office of Human Development Services and the Department of Education.
• Implementation of a program to minimize bad loan losses for the Economic Development Administration.
• Panel Member for Health Care Finance Administration expert panel on systems integrity.
• Panel Member for General Accounting Office expert panel on standards for federal claims payment systems.

 

Additional clients for statistical and fraud control services in­clude:

• The Executive Office of the President;
• The States of California, Michigan, Maryland, Louisiana, Alabama, North Carolina, Vermont, Ohio, Oklahoma, Massachusetts and Washington;
• The United States Senate;
• The United States Departments of the Treasury, Commerce, Education, Health and Human Services, Labor, Housing and Urban Development, and Agriculture;
• 21^st Century, AAA of Northern California, AAA of Southern California, Aetna, Allstate, American Re, Amica, Cal Casualty, Citation, Farmers, ICBC, Infinity, National General, Nationwide, Progressive, Prudential, Qestrel, Royal, Sequoia, Sterling, TIG, Unicare, USAA, Western Pioneer, and WCB
• National Science Foundation, Public Health Service, National Center on Child Abuse and Neglect.
• United States Court of Appeals for the Ninth Circuit;
• Coopers & Lybrand, PDA, Institute for Research in Social Behavior, Abt Associates, Analytic Systems, Evaluation Research Corporation, Invicare Corporation, Macro Associates, Science Applications International, Berkeley Planning Associates, and Advanced Technology; and
• Lawrence Hall of Science, National Institute on Drug Abuse, Women’s Educational Equity Fund, Disability Rights Education and Defense Fund, Center for Independent Living, Institute of Urban and Regional Development, Institute of International Studies

 

Employment and Education History:

 

1999-Present   President and Chairman, Decision Integrity, San Francisco CA

 

1985-Present   President, Quality Planning Corporation, San Francisco CA

 

(1993)              Founding Director, Qestrel Claims Management, Oakland CA

 

(1989)              Senior Professional Staff, United States Senate. As a public service, Dr. Finnegan took a leave of absence from Quality Planning to direct the cost and impact analysis of the Americans with Disabilities Act.

 

1980-1985       Director, Quality Assurance Division, Applied Management Sciences, Silver Spring MD.

 

1977-1979       Management Analyst, University of California at Berkeley.

 

1977-1978       Project Director, Lawrence Hall of Science.

 

1975-1978       Instructor, Lecturer, Department of Sociology, University of California at Berkeley.

Taught introductory, intermediate, and advanced social statistics and the graduate survey research methods course sequence.

 

1978                Ph.D., Sociology University of California at Berkeley

        Advanced certifications in :

           Applied Statistics

           Survey Research

 

1975                M.A., Sociology University of California at Berkeley

 

1973                B.A., Sociology University of California at Berkeley

 

National College Extemporaneous Speaking Champion, 1968.

 

Systems Developed

 

IFQS: Integrated Fraud Query System for the Insurance Corporation of British Columbia (2001)

RAMS: Renewal Audit Management System for California State Automobile Association (1999)

STARS: Sampling, Tracking, Auditing, and Reporting System for California State Automobile Association (1998)

Qest: Claims management system for Qestrel Claims Management (1994)
Mileage Calculator: Underwriting technical support software for auto insurance rating (1998).

Comply: Actuarial Software for various clients (1991)

VIPER: Fraud investigation targeting and investigator resource management system for national food stamp program (1986).

PAS-PORT: Program Assess System for public health programs in Louisiana; later adopted by other states (1987).

IAS: Integrated Application System for auto and homeowners insurance application, quoting, and underwriting for the Southern California Automobile Club.

Application Review System:   New business underwriting review system for the Southern California Automobile Club.

BISFU Monitor: Bodily Injury Special Fraud Unit productivity and savings estimation system for the Insurance Corporation of British Columbia.

MDSFU Montior: Material Damage Special Fraud Unit productivity and savings estimation system for the Insurance Corporation of British Columbia.

 

 

 

 

Example Publications and Invited Presentations:

 

May, 2000             “Auto Insurance Pricing Crisis” Senior Management Seminar, Hartford Insurance

May, 2000             “E-Business in Insurance” Training Seminar, Insurance Regulatory Examiners Society, National Association of Insurance Commissioners

January 2000        “How to Control Premium Leakage” Underwriting Trends Volume 12 # 1 January 2000

December 1999    “The Virtual Insurance Company” Annual Conference, National Association of Insurance Commissioners

May 1999              “The Virtual Insurance Company” Faculty, National Association of Independent Insurers Underwriting Seminar.

October 1998        “Detering Fraud” Keynote Speaker, International Insurance Fraud Conference, Vancouver, CA

October 1998        Insurance Fraud Interviews, CBC radio and BC TV

April 1998             “Link Analysis” Interview in Claims Magazine.

May 1993              “Law Enforcement Responses to Insurance Fraud;” Keynote Speaker, National

                             Association of Attorney Generals, Insurance Law & Policy Developments Seminar.

 

March 1993          “Measuring and Monitoring Insurance Fraud” Speaker, Pacific Insurance and Surety Conference.

March 1993           “Defeating Claim Fraud,” Speaker, Annual International Auto Physical Damage

Conference.

November 1992    “How Do You Handle Unfair and Deceptive Practices?” Speaker, Rate Rollbacks

and Insurance Regulation Conference.

August, 1992         “Bad Faith vs. Big Fraud,” Keynote speaker with Gail Simpson, Claims Handling in

                              the 1990’s Conference

June 1992             “Identifying and Handling Potentially Fraudulent Bodily injury Claims” with Gail

                              Simpson, Allstate Insurance Manual.

May 1992              “Winning the Fraud Game: Part II” Best’s Review Volume 93 1.

April 1992              “Winning the Fraud Game: Part I” Best’s Review Volume 92 12

February 1992       “Blatant Fraud Pushing Up the Cost of Car Insurance” Interview, New York Times.