Fraud Analysis

Our Investigators fraud analysis services to conduct thorough and systematic investigations relating to Criminal and Health Care Fraud matters within the jurisdiction. Our investigators handle cases independently, as lead agent or as a team member. Whether the cases involve sensitive matters or prominent individuals, organizations, or corporations, we provide the best in choice fraud analysis to your organization.

Our framework of fraud analysis includes: planning and conducting investigations of a complex and difficult nature; performing quantitative, qualitative, or other analysis of relevant facts; researching background information using various databases and sources; identifying subjects to investigate and develop leads; conducting interviews; collecting and processing evidence; and helping building financial investigations.

Healthcare Fraud Detection

Our work with the U.S. Attorney’s Office and Anthem has armed us with the expertise that you need to successfully maintain healthcare program integrity and decrease your exposure to fraudulent claims. Our analyst performs in-depth evaluation and analysis of potential fraud cases by identifying up-coding, unbundling, multiple-billing and other methods of fraud to support the development of complex cases.  

We can perform the following: 

  1. Collaborate with management, investigators, and analysts to provide reactive and proactive case development support and to fulfill law enforcement data requests.
  2. Validate data analysis results and analytically identify potential fraud, waste and/or abuse situations in violation of Medicare/Medicaid laws, guidelines, policies, and regulations.
  3. Support requests for CMS reporting requirements.
  4. Utilize data analysis techniques to detect aberrancies in Medicare/Medicaid claims data and proactively seek out and develop leads and cases received from a variety of sources including CMS and OIG, fraud alerts, and referrals from government and private sources.
  5. Work with statisticians and data analysts to provide proactive data analysis results with statistically high probabilities of producing case referrals to law enforcement, over-payments, and/or administrative actions.
  6. Prepare develop and participate in provider, beneficiary, law enforcement, or staff training as related to Medicare fraud, waste and/or abuse data analysis.