Fraud Investigation

Healthcare fraud and improper medical practices are a serious concern for payers, beneficiaries and government programs, which is why we investigate on behalf of insurance providers, Medicare and Medicaid payers, administrative contractors and government agencies. We care about America’s healthcare system and want to clear the way for responsible and ethical provider care. We objectively analyze each case presented to our expert teams and provide evidence based assessments on the appropriateness and quality of care which patients receive.

Our Special Investigation and Review teams are composed of seasoned experts. They are experienced and trained Medical Doctors, Registered Nurses, Coders, Researchers, Investigation Specialists, Administrators, and technical support staff. Our combined team’s experience encompasses clinical, billing, and investigation. We audit a range of healthcare providers across every state in the nation.

We Review Healthcare Providers in Every Specialty

Below is a list of the main specializations we review.

Our Investigation and Audit Specialists review patient files, medical records, and provider data presented to us. We work in coordination with our support teams to develop the workflow and process for each case with our reviewing Doctors, Registered Nurses, and subject matter experts. Each case goes through a rigorous assessment where evidence and supporting documentation is identified, researched, and analyzed to complete a comprehensive review.

Healthcare Fraud Investigations provides an assessment and review of every high risk case presented to us. We are committed to providing in-depth analysis for our stakeholders. Each case we investigate goes though a multi-tier quality control processes to ensure accuracy, and to present the best determination possible.