The value of modus operandi in fraud investigation : a short-term insurance industry perspective

Abstract

This study sought to examine the value of modus operandi (MO) information in the investigation of short-term insurance fraud. A comprehensive literature study was conducted concerning the dynamics of MO information in forensic investigation and short-term insurance fraud in South Africa and internationally, and individual semi-structured interviews were conducted with forensic investigators at Santam and MiWay to promote knowledge and understanding of the importance of MO information in short-term insurance fraud investigations. Results of this research indicate that participants did grasp the significance of MO information in the investigation of short-term insurance fraud. It is, however, apparent that they did not optimally exploit MO information regarding insurance fraud as a result of limited experience, ineffective databases and the inaccessibility of available data – all of which prevent the improvement of utilising MO data pertaining to short-term insurance fraud. Forensic investigators in the short-term insurance industry isolate themselves from each other and fail to share the available MO information amongst each other, resulting in a non-systematic fragmented approach to short-term insurance fraud investigation. The study identifies the challenges and shortcomings experienced by forensic investigators at Santam and MiWay that prevent the optimal utilisation of MO information in the investigation of short-term insurance fraud. The study then suggests a set of recommendations that could assist forensic investigators and other role-players in enhancing the utilisation of such information.