Medical Provider Fraud Investigations on the Rise

It was only 10 years ago that most private investigators working for insurance carriers were confined to investigating the claimant’s true activities and abilities. Today, medical provider fraud investigations are one of the fast growing areas of insurance fraud being handled by private investigators like those at Sherlock Investigations. In these medical provider fraud investigations, the medical provider usually does one of the following: inflates the billings to the insurance company, knowingly submits bills with improper medical codes, misrepresents the facts of the care provided or simply fails to provide any care at all but still bills the insurer. One growing area of healthcare fraud investigations involves the use of private investigators to conduct clinic inspections of the medical providers facilities. Surveillance is another highly effective way to gather evidence of who is providing care and who is receiving same. This is a growing area on investigation in Michigan, particularly in metro-Detroit. in many cases the same fraudulent medical providers billing insurance companies are also defrauding the government medical systems.