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Insurance Fraud

PRIVATE INVESTIGATOR | STRYKER INVESTIGATION SERVICES

STRYKER’S INVESTIGATION OFFICE: (800) 733-1950 INSURANCE REFERRAL FORM

Insurance Fraud Investigations 

Insurance Fraud Investigations (800) 733-1950. We conduct Insurance Fraud investigations; Health Insurance Fraud, Auto Insurance Fraud, Medical Care Provider Fraud, and claims investigations on behalf of insurance carriers and other entities. These services include Workers’ Compensation insurance fraud Subrosa surveillance and 4-hour activity checks, home care, hospice caregiver integrity investigations, employer level accident investigation AOE/COE statements from the Claimant and witnesses, and third-party subrogation and identify property owners, individuals, responsible parties, or entities involved and fraud investigation focused on suspicious claims, surveillance; as well as, other insurance-related investigation requests.

We provide our clientele with a comprehensive battle-tested Workers’ Compensation (“Workers’ Comp”) insurance fraud and defense program, focused on suspicious claims, surveillance; as well as, other insurance-related investigation requests. Consequently, our focused performance will bring our clients exceptional work product and unparalleled service results for insurance companies, municipalities, third-party administrators (“TPA”) law firms, their attorneys, and private clients, to help mitigate the loss and exposure on even the toughest claims.

We recognize fraud occurs in simple and complex schemes of intentional misrepresentation or concealment. Unlike errors or mistakes, fraud is deliberate and maybe intentionally hidden. For this reason, we use creative strategies to determine the presence of deception which is intended to achieve financial or personal gain at the expense of a victim. Every investigation is unique, and there is no one-size-fits-all approach. We work directly with the examiners, attorneys, and management to conduct the services around a key or significant claim activity. Each insurance investigation is tailored towards the unique needs of a particular client and designed on a case-by-case basis to uncover the nature and extent of the deception and expose fraudulent and/or abusive claims. 

Multiline Insurance, Property, Casualty, Life and Health Investigative Services

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  • checkmarkWork Comp Record Check

    checkmarkSkiptrace / Individual Locate

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  • checkmarkSocial media Investigation

    checkmarkHospital / Pharmacy Check

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  • checkmarkAlive and Well Check

    checkmarkSubrosa Surveillance

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Everyone should have immediate access to expert investigative resources to help with their insurance defense and mitigate claims and other suspect insurance transactions. Stryker provides on-demand investigative expertise and consultations. Our areas of focus for the insurance investigation program are Workers’ Compensation (Workers’ Comp) Liability AOE/COE, Surveillance, Subrogation investigations, and (SIU) anti-fraud program. We have a clear understanding of what it takes to provide actionable information to expose exaggerated and patently false claims. Our sophisticated insurance investigations are a tried-and-true defense designed to identify potentially fraudulent and/or abusive claims. Should surveillance be necessary or requested Stryker will work directly with the examiners and management to conduct the services around a key or significant claim activity?

Services include Workers’ Comp Fraud, AOE/COE statements, and interviews, subrogation investigation, surveillance, background checks, alive and well checks, DWC record requests, records research, skip-trace, social media searches, investigations, hospital and pharmacy checks, evidence gathering, accident scene canvass, and insurance fraud-related services. Contrary to what most people believe, workers’ compensation fraud is more than just an employee exaggerating his medical condition or working for cash while supposedly disabled. While these things do occur, employers are also committing fraud by underreporting their payrolls to receive lower premiums and health care providers are billing for services they’ve never performed. Workers Compensation Insurance Fraud is costing the industry and citizens of our state billions of dollars each year.

FRAUD INVESTIGATION TACTICS 

  • Surveillance – Investigators may use audio, video, and other types of surveillance to determine whether an individual worker is as injured as they claim.
  • Document Review and Verification – Conduct a Social Security number verification. The IRCA prohibits an alien from using “any document lawfully issued … to a person other than the possessor” to get a job.
  • Interviews and research – Workers’ compensation investigators may interview colleagues, friends, family, and other individuals to learn whether there is an issue of fraud and, if so, how great.
  • Background checks and records research – An investigation into worker’s compensation fraud may include checking medical records, employment records, and other records. Private investigators may also run background checks to see whether a worker has filed numerous compensation claims in the past or if the company has a history of misclassifying employees.
  • Evidence gathering – Workers compensation investigators can gather evidence if they uncover workers’ compensation insurance fraud. This can help employers and businesses prosecute fraud and cut off worker’s compensation claims that are not legitimate.

SERVICES FOR INSURANCE COMPANIES, LAW FIRMS, MUNICIPALITIES & TPA, EMPLOYERS AND BUSINESSES

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    WORKERS’ COMPENSATION FRAUD:

    Workers’ compensation fraud occurs when a claimant, employer, or health care provider knowingly lie in order to gain an advantage, savings, money, or other benefits. For employers-private and government alike-workers’ compensation fraud increases the cost of providing insurance benefits to employees and, in turn, increases the overall cost of doing business. For many Americans, the increased expense resulting from fraud could mean the difference between making health insurance a reality or not.

  • AUTO INSURANCE FRAUD:

    Staged car accidents are typically carefully planned and practiced. Some criminals stage accidents in which they purposely collide with another car, then accuse the other driver of fault in order to file claims. Others attempt vehicle theft fraud, trying to get money for a car that is not stolen. Use our private investigators to search for and collect evidence. Stryker’s private investigators and insurance investigators will make sure the claimant is indeed injured by keeping an eye on their activities, speaking to their friends and relatives, or digging up criminal records. Today it’s easier with the widespread use of social media. A Facebook search could be all it takes to build a case.

  •  MEDICAL PROVIDER INSURANCE FRAUD:

    Excessive or redundant medical services, medical coding errors, improper billing, as well as outright fraud, continue to be a significant challenge for health insurers.  Healthcare fraud, waste, and abuse analytics identify questionable provider practices and prioritize work for investigators, then measures the impact of the actions taken to further reduce the losses and promote best practices among providers. People who submit fake claims often don’t think they will get caught. If they look calm after submitting a complicated claim or hand over receipts for damage repairs written by hand, the agent might dig a little further.

  • HEALTH INSURANCE FRAUD:

    The majority of health care fraud is committed by a very small minority of dishonest health care providers. Sadly, the actions of these deceitful few ultimately serve to sully the reputation of perhaps the most trusted and respected members. Claims analytics provides many other benefits beyond identifying potential fraud, waste, and abuse. It can pinpoint subrogation opportunities and the likelihood of claim litigation. With an increased focus on healthcare costs, investigators are pursuing and prosecuting fraudulent activity much more aggressively. 

WORKER’S COMPENSATION FRAUD – IS ILLEGAL

Workers’ comp fraud can be committed by employers, employees, and even health care providers. What is workers’ compensation fraud? Workers’ compensation fraud occurs when someone willfully makes a false statement or conceals information in order to receive workers’ compensation benefits or prevents someone from receiving benefits to which they might be entitled. Insurance fraud occurs when people deceive an insurance company in order to collect money to which they are not entitled.

This particular fraud is a crime in all fifty states, and the majority of the states have established fraud bureaus to identify and investigate fraud incidents. In most states, fraudulent claims can be either a felony or a misdemeanor, depending on the nature and extent of the fraud committed. Certain types of fraud, such as health care fraud, are also crimes under federal law. Workers’ compensation fraud is a crime. To avoid allegations of fraud, it’s very important that you follow your doctor’s orders precisely. Do not engage in any activities the doctor advises against, including lifting, bending, and stooping. Additionally, you should keep in mind that the only income you receive should be from your workers’ compensation benefits. Babysitting, mowing lawns, or cleaning houses for extra cash on the side is not allowed.

THE COST OF FRAUD

The insurance industry consists of more than 7,000 companies that collect over $1 trillion in premiums each year. The massive size of the industry contributes significantly to the cost of insurance fraud by providing more opportunities and bigger incentives for committing illegal activities. The total cost of insurance fraud (non-health insurance) is estimated to be more than $40 billion per year. That means Insurance Fraud costs the average U.S. family between $400 and $700 per year in the form of increased premiums. FBI Publications

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