When something doesn't look right, we go deeper.
Independent fraud assessment and investigative support for organizations facing suspicious claims, emerging patterns, complex litigation, potential organized activity or uncertainty about the strength of their current fraud program.
Focused review. Broader intelligence. Better decisions.
Claims Oversight
Independent oversight of complex, high-exposure, suspicious or strategically important claims, adding another layer of intelligence and review.
Claims Audit
Independent audits of claims handling against industry best practices and your organization’s standards, covering documentation, coverage review, reserving, investigation, payment accuracy and resolution. Identify gaps, reduce claims leakage and develop actionable recommendations to strengthen quality, consistency and accountability.
Fraud Investigations
Focused investigation involving individual claims, groups of claims, providers, organizations, vendors, attorneys, contractors or suspected coordinated activity.
Fraud Recoveries
Identify and evaluate opportunities to recover payments associated with substantiated fraud. Analyze claim and payment records, quantify potential losses and organize supporting evidence to help your team and legal counsel pursue appropriate recovery strategies and prevent repeat losses.
RICO Feasibility Assessment
Evaluation of claim patterns, participants, relationships, alleged predicate activity, potential enterprise structure, damages and available evidence to help counsel determine whether deeper RICO analysis is appropriate.
Program Evaluation & Strategy
Review of fraud programs, SIU workflows, referral criteria, escalation, analytics, documentation, vendor coordination, training, intelligence sharing and outcome measurement. Develop defensive strategies to address identified fraud and create and implement proactive measures suited to your organization.
Claim & Case Reviews
Independent analysis of unusual claims or litigation involving suspected fraud, questionable treatment, excessive billing, organized activity, complex liability or repeated participants.
Forensic Reviews & Investigation
Broader examination of participants, businesses, financial relationships, litigation, treatment, corporate structures and related claims to understand how an activity operates and where the evidence leads.
A fraud program should do more than satisfy a requirement.
It should create a repeatable system for recognizing, escalating, investigating and learning from suspicious activity.