How Many Bad Healthcare Providers

Are Using Your Injury Claims as their Personal Goldmines?

 

Annually in the United States, healthcare frauds exceed $68 billion dollars!

 

How much of that staggering amount of money is coming directly out of your organizations pockets?

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Don't Let Your Claims Administrator Skirt the Issue by Telling You That They Use a Medical Bill Review Service.  Bill Review Merely Reduces Provider Billing Down

to the Acceptable Reimbursement Rate Allowed in That Region or Jurisdiction. 

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But...Medical Bill Review Does Not Test for Fraud!

 

If a Provider Billed $1K for a Treatment That is Only Reimbursable at $400, Bill Review Will Reduce the Bill Down by $600.  Of Course They Will Because $400 Was All That The Provider was Entitled to Anyway.

 

But... If the Healthcare Provider Billed Your Injury Claim for $1K of Treatment that They Never Actually Performed, Even with the Medical Bill Review Reduction, You Would Still be Paying $400 Too Much!

 

Has your insurance company, your third party administrator (TPA), or their respective special investigations unit (SIU) ever shared the huge injury claim vulnerability you have to healthcare & provider frauds?

 

We will!

 

As Certified Fraud Examiners with over 13 years of subject matter expertise, we can tell you with confidence that it’s not a worry over if your injury claims are being affected by healthcare and provider frauds, it’s an actual problem of how bad your claims are being impacted…and what your claims administrator is doing about it.

 

Does Your Claims Administrator Protect You

from Healthcare & Provider Frauds, Waste, & Abuses?

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• Do you know?

 

• How do you know?

 

• What does your TPA do?

 

• How often does your TPA do it?

 

• How effective is your TPA at preventing, detecting, & mitigating your healthcare fraud risk?

 

• If suspected healthcare or provider fraud is detected, how does your TPA handle it?

 

A Shocking Number of Insurance Companies & Third-Party Administrators

 Never Even Test for Healthcare & Provider Frauds in Injury Claims!

 

Is Yours One of Them?

 

Why on earth don’t they test?

 

Two common reasons:

 

1. Because their scope is too narrowly focused on just claimants and injured workers, allowing the bad healthcare providers to pillage your claims without challenge.

 

  2.  Because they simply don’t know how to prevent, detect, or mitigate healthcare & provider frauds in your claims.

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Both of these common reasons should shock and concern you greatly!

 

Please Consider This Logically...

 

How can a claimant or injured worker who is suspected of faking an injury or exaggerating the extent of their injury be able to pull off a scheme like that without the conspiring help of bad healthcare providers to support the allegations?

 

The same healthcare providers who are also looking to cash-in on those injury claims at your organizations expense!

 

The answer is: They Can’t!

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Should You Have to Pay Fraud Experts Like Us to Help You Police This?

No! Of Course, Not...

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But the Truth May Be That You're Already Paying...

You're Just Not Getting Everything You Thought You Were Paying For! 

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Your Claims Administrator Should Be Protecting You

from Both Claimant Frauds AND Healthcare Frauds.

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If They Aren't, You're Paying Full Price for Only Partial Protection...

And That's Just to Them! Compound That by How Many Bad Healthcare Providers

Are Defrauding Your Injury Claims at the Very Moment You're Reading this.

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It's YOUR Organizations Money at Risk. If You Don't Properly Protect It, No One Will!

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As Your Organizations Risk Management Professional, Imagine What a Hero You Will Be

by Helping to Routinely Save an Extra $10K, $50K, $100K or More in Claims Costs 

That Would Have Been Paid But-For Proper Insight & Investigative Oversight!

 

Finally, the accountability self-insured organizations & municipalities have been looking for!

 

Engage Us as Your Secret Weapon to Hold Your Insurer, TPA, SIU, & PI’s Accountable

for the Proper Investigation of Your Questionable & Suspected Fraudulent Injury Claims

 

Adjusters have a duty and responsibility to investigate injury claim allegations, especially those believed to be questionable or suspected fraudulent.

 

But as a self-insured entity how do you really know whether the investigation performed was proper, or whether evidence developed during the investigation was suitably used by the adjuster to help mitigate financial exposures in your claims?

 

• Do you feel forced to simply take your claim administrators word for it?

 

• Did the adjuster order an investigation and then simply “check off” that box with no follow-up, no recognition of results, or no application of the information and evidence uncovered?

 

• Does high claim volume vs. limited staffing cause shortcuts to be taken? Shortcuts that might make life easier for adjusters, but cause injury claim costs to be considerably higher for you?

 

• If an SIU investigator or private investigator was used, was the investigation properly focused, thoroughly performed, and the results accurately chronicled in their reporting for use by claims?

 

These are but a few concerns you should have when you entrust others with the stewardship of your hard-earned money.

 

In a perfect world people would hold the honor of being responsible for other people’s money with great esteem and respect. Unfortunately, this isn’t always the case.

 

In fact, because the money at risk isn’t their own, some people may be far more quick to be reckless with it.

 

“It’s Easier to Pay a Claim than to Fight it”

 

Despite your fantastic level of importance, some self-insured organizations and municipalities may actually be treated like “necessary evils” behind your backs.

 

This may be most evident when dealing with requests for investigations spawned from questionable or suspected fraudulent claims. Do you experience push-back or rationalizations when you request that a claim be investigated or express your concern that one of your claims may be questionable or suspected fraudulent?  

 

If so, this is because some adjusters may decide that it’s easier for them to pay the claim than to fight it.

 

We can help you fight that unfortunate and unprofessional contention.  

 

Though we have over 30 years of investigative experience, Insurance Fraud Consultant of America, LLC is not a private investigative agency. We are a uniquely specialized consulting firm focused on improving insurance fraud detection and mitigation results while concurrently lowering future exposure to fraud risk and loss.

 

We represent huge financial value to self-insured organizations and municipalities whose own money is at high risk of loss due to the improper and/or ineffective investigation of insurance frauds. How? By being your gap-fillers, helping to educate you & partner with you on fraud vulnerabilities that you may have never before knew you were exposed to.

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Why didn't you previously know about these fraud vulnerabilities? Unfortunately, it may be because those who you hired and trusted to fully protect you and your injury claims, simply weren't. Where's your ROI on that?

 

It’s Your Money at Risk! Confirm & Monitor That it is Being Spent Wisely

 

As your independent insurance fraud risk expert, advisor, and advocate, we will help you to confirm and monitor, by leveraging over 25 years of national injury claim and healthcare fraud expertise to

• review,

• assess, and

• provide you with detailed advisory opinions

regarding whether your

• claims administrator,

• their respective SIU’s

• or private investigators

performed a proper good faith investigation on your behalf.

 

This includes whether evidence developed during the investigation was used to its maximum effect in helping to mitigate financial exposures in your claims.

 

If we assess that the investigation was not properly performed, or missed opportunities, we will provide you with the

• points of contention;

• questions to ask; and

• process improvements to insist on going forward to ensure proper future performance.

 

If we find that their actions were proper, our involvement provides you with the value of confirmation.

 

This is exactly why you need the benefit of our expertise.

 

We will help guide you through the fortification of your anti-fraud processes and safeguards, while also helping you to hold your claims administrator and their investigators accountable.

 

To receive our Free Special Report and to learn more about how Insurance Fraud Consultants of America, LLC can help your organization or municipality, simply complete the brief form below.

 

Please add “Self-Insured Advocacy” on the Subject line.

 

Your free information will arrive by direct email reply shortly.

 

Thank you for your interest! We look forward to servicing you soon!

 

All the Professional Best.

 

Sincerely,

Bo Barber, CFE

National Director

 

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