David L. Cohen, CFE, ALHC
Professional Investigator/ Investigative staff at NYS OPMC
- Greater New York City Area
- Security and Investigations
David L. Cohen, CFE, ALHC's Overview
- Investigative staff at New York State Office of Professional Medical Conduct(OPMC)
- 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
- Legal Investigator/Claims Investigator at New York State Insurance Fund
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
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
New York State Office of Professional Medical Conduct(OPMC)
February 2009 – Present (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
Public Company; 10,001+ employees; UNM; Insurance industry
1995 – 2008 (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 1986 – October 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.
Legal Investigator/Claims Investigator
Government Agency; 1001-5000 employees; Insurance industry
July 1980 – February 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
- Certified Fraud Examiner
- Background Checks
- Investigative Reporting
- Fraud Detection
- Investigative Research
- Claim Investigation
- Due Diligence
- Insurance Investigation
- Healthcare Investigation
- Fraud Investigation
- Investigative Interviewing
- Database/Internet Investigation
- Professional Networking
- Legal Investigations/Litigation Support
- Disability/Life Insurance Investigation
- Claims Management
- 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
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
- expertise requests
- reference requests
- getting back in touch
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