ANTI-FRAUD PROGRAM SUPPORT
Anti-Fraud Program Support
Operational and documentation support for approved anti-fraud programs, with jurisdiction-specific legal or regulatory requirements left to the carrier, counsel, and appropriately qualified compliance professionals.
BUYER LENS
Know what this service should answer before you scope it.
What factual question must be developed, documented, or resolved without turning the investigator into the claim decision-maker?
Good reasons to start here
- The file contains conflicting or incomplete facts.
- A witness, scene, activity, relationship, or chronology requires independent development.
- A suspicious or complex matter needs a defined investigative path rather than open-ended monitoring.
What to have defined
- The authorized investigative question and assignment purpose.
- Known parties, chronology, and relevant records already held by the client.
- Any jurisdiction, representation, contact, or escalation restrictions that govern the work.
What this should inform
A clearer factual record for the carrier, TPA, counsel, or other accountable authority to evaluate.
ACCOUNTABLE OWNERSIU, claims, counsel, or the authorized matter owner.CAPABILITIES
Disciplined support built around the matter.
MODLAN scopes each engagement to the authorized assignment, applicable requirements, available evidence, and client objectives. Work is documented for clarity, defensibility, and appropriate downstream review.
Procedure supportProgram documentationWorkflow reviewReferral process supportControl evidenceCounsel/compliance coordination
WHEN THIS SERVICE FITS
Built around a defined operational question.
- A program needs operational support around its existing anti-fraud framework.
- SIU procedures, roles, documentation, and referral pathways need to be organized.
- The organization wants evidence that program activities are being performed consistently.
SCOPE
What the engagement can include.
The exact scope is established by the authorized assignment, applicable licensing or professional requirements, and client guidelines.
OPERATING MODEL
Controlled from assignment through handoff.
Inventory
Identify the client-approved anti-fraud obligations and operating procedures relevant to the engagement.
Map
Connect roles, controls, evidence, and escalation paths.
Operate
Support approved program activities without inventing jurisdiction-specific legal requirements.
Evidence
Preserve records that demonstrate what the program did and when.
WORK PRODUCT
What the matter can produce.
- Operational control mapping
- Procedure-support documentation
- Program evidence references
- Escalation or gap observations
CONTROL BOUNDARY
What keeps the work defensible.
- Counsel or qualified compliance professionals confirm legal requirements.
- No public page claims a universal anti-fraud plan satisfies every jurisdiction.
- Program content remains client-confidential.
- Controls should be evidenced, not merely described.
SERVICE FAQ
Procurement and operating questions.
Will MODLAN write a legally sufficient anti-fraud plan for every state?
Not as a universal public promise. Legal sufficiency is jurisdiction- and program-specific and should be reviewed by appropriate counsel or compliance professionals.
Can you help operationalize an existing plan?
Yes. That is the primary posture of this service.
Can training and referral workflows connect to the plan?
Yes, where those functions are included in the program scope.
Can controls be tracked in the compliance platform?
MODLAN's internal assurance architecture is designed to record control ownership, testing, evidence, and exceptions.
WHERE THIS SITS IN MODLAN
Special Investigations & Program Support
Develop facts, evidence, patterns, or program context for authorized SIU work.
Explore the operating family →SIUTechnology relationship
CST may support approved intelligence context while investigative conclusions remain human-reviewed and source-attributed.
View the full MODLAN service ecosystem →HOW THIS SERVICE CAN SCALE
From assignment to enterprise program—without changing who owns the decision.
A defined objective, scope, owner, evidence/data path, and handoff for a specific matter or task.
Recurring or overflow use of the same capability under established client rules, controls, and escalation paths.
The service becomes one governed lane inside a broader multi-service operating model with explicit dependencies.
PROCUREMENT & IMPLEMENTATION
Questions to resolve before this service enters production.
Enterprise delivery depends on the operating context around the service—not merely the capability itself.
PROGRAM FITSIU Program
Explore program architecture →See how this capability can operate as a matter, overflow resource, or governed SIU program component.
DECISION CONTEXT
This service does not operate in isolation.
The engagement should connect to the correct buyer, adjacent operating layer, and assurance boundary without blurring professional authority or the source of record.
ENTERPRISE JOURNEY
Connect this service to the rest of the operating model.
Move from service selection into the adjacent operational, evidence, integration, assurance, or intelligence layer that the matter actually requires.
MODLAN SYSTEMS
Bring the right people, evidence, and intelligence to the problem.
Contact MODLAN to discuss the authorized scope, geography, timing, and operational requirements for your matter.