Health Care Fraud

Health Care Fraud Investigations: health insurance fraud, pharmacy fraud, and medical fraud. Insurance fraud is when a company or an individual defrauds an insurer or government health care program, such as Medicare/ Medicaid or other State programs. There are several ways to circumvent the law, and those committing these acts are creative. Damages from fraud can be recovered in many ways, False Claims Act, Qui Tam, and others, and these damages can be extensive.

Types of Cases

  • Excessive services
  • Billing for services not rendered
  • Upcoding of services
  • Upcoding of items
  • Duplicate claims
  • Unbundling
  • Unnecessary services
  • Kickbacks
  • Copied and pasted entries into the medical record

Surveillance and witness testimony are the best way to prove these factors, and that is where our dedicated investigators can help.

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*Healthcare investigations need a minimum of 5 hours (quantity of 5 at checkout). This is to ensure a minimum standard of quality. If more hours are desired for a more thorough investigation, both the customer and investigator will communicate that need. Customers are never charged without their approval.