David L. Cohen, CFE, ALHC

David L. Cohen, CFE, ALHC

Professional Investigator/ Investigative staff at NYS OPMC

Location
Greater New York City Area
Industry
Security and Investigations

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David L. Cohen, CFE, ALHC's Overview

Current
  • Investigative staff at New York State Office of Professional Medical Conduct(OPMC)
Past
  • Field Consultant - Regional Investigator at Unum
  • Supervising Investigator/Senior Investigator at New York State Office of Professional Medical Conduct(OPMC)
  • Investigator(Peace Officer) at New York State Department of Motor Vehicles - Office of Field Investigation and Audit
Education
Connections

500+ connections

David L. Cohen, CFE, ALHC's Summary

Over 30 years of experience as a professional investigator, including over 18 years with state government as a workers’ compensation, auto crime, and regulatory(professional misconduct) investigator including 6 years as a supervising investigator. Worked as an insurance company regional field investigator, specializing in disability insurance investigations with an emphasis on fraud detection, as well as accidental death & dismemberment and life investigations, for over 12 years. Interest in professional training and development; have attended many seminars, workshops, conferences, and training courses over the past 25 years.

Association of Certified Fraud Examiners(ACFE) - Certified Fraud Examiner(CFE) - January, 1992

International Claim Association(ICA) - Associate, Life and Health Claims(ALHC) - awarded 1/31/2001

Specialties

Interviewing; database/Internet investigation; networking; knowledge of government/law enforcement at all levels; insurance industry knowledge and contacts; government/law enforcement/private sector investigative and security contacts.

David L. Cohen, CFE, ALHC's Experience

Investigative staff

New York State Office of Professional Medical Conduct(OPMC)

February 2009Present (5 years 8 months)

Investigation of complaints and allegations regarding alleged professional misconduct by physicians and physician’s assistants in New York State, including incompetence/negligence, impairment, fraudulent practice, and sexual abuse.

Field Consultant - Regional Investigator

Unum

Public Company; 10,001+ employees; UNM; Insurance industry

19952008 (13 years)

Responsible for field management/investigation of individual disability, group disability, life, and AD&D insurance claims. Interviewed policyholders, claimants, employers, health care providers; obtained information from health care facilities/providers, law enforcement, regulatory, and government agencies; transcribed detailed reports. Provided direction to home office personnel regarding administration and disposition of claims per field investigation findings. Worked with Surveillance Management Unit(SMU) regarding assignment of and direction of surveillance; prior to establishment of SMU, actively managed surveillances and liaisoned with vendors. Worked with Special Investigative Unit(SIU) regarding fraudulent claim investigations and special assignments. Provided sworn depositions and testimony when required; assisted in settlement of claims in consultation with home office staff when requested.

1995-1997 - Zone Claims Manager, Provident Life and Accident Insurance Company

1997-1999 - Field Consultant, Provident Companies

1999-2007 - Field Consultant, UnumProvident Corporation

2007-2008 - Field Consultant, Unum Group

Supervising Investigator/Senior Investigator

New York State Office of Professional Medical Conduct(OPMC)

January 1986October 1995 (9 years 10 months)

Supervising Investigator: December, 1988 – October, 1995
Provided management and leadership to an investigation unit to ensure the appropriate, timely, and effective investigation of complaints regarding alleged professional misconduct by licensed physicians and physician assistants in New York State. Reviewed, evaluated, and assigned all unit cases; acted as general liaison with prosecuting attorneys and coordinator of requests for additional investigation. Specialist in coordinating fraud investigations and maintaining liaison with the insurance industry, as well as with law enforcement and regulatory agencies.

Senior Investigator: January, 1986 - December, 1988
Investigated complaints and allegations regarding alleged professional misconduct by physicians and physician’s assistants in New York State, incompetence/negligence, impairment, fraudulent practice, and sexual abuse.

Investigator(Peace Officer)

New York State Department of Motor Vehicles - Office of Field Investigation and Audit

February 1985January 1986 (1 year)

Legal Investigator/Claims Investigator

New York State Insurance Fund

Government Agency; 1001-5000 employees; Insurance industry

July 1980February 1985 (4 years 8 months)

Legal Investigator: August, 1982 - February, 1985
Investigated liability and damage aspects of court cases in which the State Insurance Fund or its policyholders were, or might be involved as parties.

Claims Investigator: July, 1980 - August, 1982
Investigation of Workers’ Compensation claims.

David L. Cohen, CFE, ALHC's Skills & Expertise

  1. Certified Fraud Examiner
  2. Background Checks
  3. Investigative Reporting
  4. Fraud Detection
  5. Investigative Research
  6. Claim Investigation
  7. Due Diligence
  8. Insurance Investigation
  9. Healthcare Investigation
  10. Fraud Investigation
  11. Investigative Interviewing
  12. Database/Internet Investigation
  13. Professional Networking
  14. Legal Investigations/Litigation Support
  15. Disability/Life Insurance Investigation
  16. Government
  17. Claims Management
  18. Business Networking

David L. Cohen, CFE, ALHC's Certifications

  • Certified Fraud Examiner

    • Association of Certified Fraud Examiners
    • License Cert. #5749
    • January 1992
  • Associate, Life and Health Claims

    • International Claim Association

David L. Cohen, CFE, ALHC's Education

John Jay College of Criminal Justice

Public Administration - Graduate Program

19881999

John Jay College of Criminal Justice

Bachelor of Science (B.S.), Criminal Justice

19771984

David L. Cohen, CFE, ALHC's Additional Information

Groups and Associations:

Association of Certified Fraud Examiners(ACFE) - National & New Jersey Chapter Member; Certified Fraud Examiner(CFE) - January, 1992; International Association of Auto Theft Investigators(IAATI) - National & Northeast Chapter; John Jay College Alumni Association; ASIS International; ASIS - Central New Jersey Chapter; Society of Investigators of Greater Newark(SIGN); Concerns of Police Survivors(COPS).

Contact David for:

  • career opportunities
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  • reference requests
  • getting back in touch

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