INSURANCE CLAIMS INVESTIGATIONS / WORKERS’ COMP FRAUD SERVICES

INSURANCE CLAIMS INVESTIGATIONS: We provide multi-line insurance claim investigations that are battle-tested insurance defense services. These services include Workers’ Compensation Subrosa surveillance, 4-hour activity checks, home care, and hospice caregiver integrity investigations, employer level accident investigation AOE/COE statements from the Claimant and witnesses, subrogation investigations to identify responsible parties, property owners, individuals, or entities involved and fraud investigation focused on suspicious claims, surveillance; as well as, other insurance-related investigation requests. We provide insurance defense services to insurance carriers, third-party administrators, law firms, municipalities, and employers from the private sector.

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.

Everyone should have immediate access to expert investigative resources to help with their insurance defense and mitigate insurance 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.

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

Background Investigation

Claimant Home Interviews

Alive and Well Check

Activities Checks
Medical Records Retrieval

Hospital Canvass

Pharmacy Canvass

Gym Canvass
Statements – Recorded & Signed

Witness Interviews

Claimant Interviews

Liability Investigation Subrogation
Surveillance

Social Media Investigations

AOE/COE Statements

Investigative Surveillance

ALIVE & WELL CHECK | PHONE INTERVIEW & IN PERSON

We can validate your claimant’s current health status, medical treatment, and present address with an “Alive and Well Check,” and ensure the claimant is, in fact, alive and well and they are receiving benefits. Our investigator will ask for verification of employment and/or disability status, social security number and date of birth verification, telephone number, spouse, and children information, and photographs of the claimant at his residence.

CAREGIVER INTEGRITY INVESTIGATIONS & SURVEILLANCE

Caregiver integrity investigations. Do you suspect Caregiver Fraud? Do you suspect caregivers are not arriving as scheduled at the patient’s residence? Do you suspect the caregiver of billing for the time they were not providing care? Do you suspect neglect, poor conditions, elder abuse, the theft of Rx medications, or missed treatments? A licensed private investigator can conduct surveillance to confirm that caregivers adhere to their schedules and best practices.

There are many caregiver professionals who go above and beyond; unfortunately, there are those who do not have the best intentions. Trust is a fundamental part of any relationship, especially those between seniors, their family members, and professional caregivers. Establishing trust takes time, but most care providers and receivers do not have the luxury of getting to know one another well before their relationship begins. Can installing cameras help to strengthen or undermine the trust a family places in professional caregivers and long-term care facilities?

Identify any risks of HIPAA violations while surveillance cameras. Prior to the installation of any surveillance or monitoring device, a risk assessment should be conducted by a private investigator who specializes in privacy rules and guidelines and knows what to look for. The risk analysis will identify any potential risk to patient privacy using while using video and audio recording devices. There are several benefits that video equipment can give aside from it is an inexpensive means of addressing the ever-increasing security concerns in a residential care facility, hospital, and at the patient’s residence. As a representative, a private investigator has the right to visit and check on the care of the patient.

Billing patients or insurance companies for services that were never provided;
Padded” insurance claims that include actual services that were rendered along with additional or extra services that were never provided;
Upcoding” – charging patients or insurance carriers for services and or procedures that are much more expensive than the services that were really provided.

As a final point, Stryker concentrates our knowledge, skills, and expertise on a specific type of insurance investigation defense program that has been honed over the last two decades, as such, our focused performance will bring our clients exceptional work product and unparalleled service results.

SUBROGATION INVESTIGATIONS | SCENE INSPECTIONS | INTERVIEWS

Subrogation is your opportunity to conduct a causal investigation and identify property owners, individuals, responsible parties, or entities involved. Determine any contributing factors and establish if there is any contributory negligence, immediate cause, intervening cause, proximate cause or proximate consequence and establish any negligence. If any legal cause is identified and can be proven it is possible to recover the money you have paid for damages caused by a third party.

We concentrate our knowledge, skills, and expertise on specific products and investigative services that encompass all aspects of Workers’ Compensation Investigations – Insurance Defense, fraud, deceptive practices, pre- and post-litigation support. Consequently, our focused performance will bring our clients exceptional work products and unparalleled service results in all of our insurance investigations and related services.

DOCTOR OFFICE | HOSPITAL MEDICAL CLINIC | URGENT CARE CANVASS

Our Medical Office, Pharmacy Checks Canvasses are designed to contact the 15 closest medical facilities in a specific geographical area, up to a 10-mile radius. The investigation is a comprehensive canvass of all hospitals, clinics, and pharmacies around the Claimant’s residence on the date of loss or injury. No matter the line of insurance involved the objective is to discover other medical providers involved and be able to further validate or discover other medical providers involved in treating the claimant.

Stryker’s canvass program is an effective tool for investigators to determine whether there has been any previously undisclosed medical treatment(s) obtained by the subject, which may reveal a pre-existing injury or treatment prior to the alleged date of loss. You can use this information to dispute the extent of injury issues and questionable dates of injury. Every investigation report has the same basic objective…even the canvass reports. Their objectives are to collect, assemble, and preserve evidence. Find facts known to be true and those that may be presumed from all the evidence. Gather the best available evidence with the least possible delay and make determinations and recommendations for administrative disposition. Stryker’s canvass reports include a detailed chart depicting the search findings and a map of the area canvassed. Also included are standard database search results with the subject’s social security number, date of birth, possible aliases, and address history, when available. This can be useful in locating previous addresses where the subject may have prior medical treatment records.

Types of Insurance Fraud Investigations

If you need to conduct an accident investigation or canvass for witnesses, talk to Stryker about our services.

Auto Insurance Fraud:

Staged car accidents are typically carefully planned and practiced. Some criminals stage accidents in which they purposely collide with another car and 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.
If you suspect fraud, talk to a private investigator, detective, or our insurance investigator at Stryker (800) 733-1950

Health 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 measure the impact of the actions taken to reduce the losses further 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.
Insurance Investigators | Surveillance, Background Checks, Records Research, AOE/COE Statements, Accident Scene. Call and talk to a professional investigator.

Workers Compensation Insurance 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.
If you suspect improper billing practices, talk to Stryker about our investigation services.

Medical Provider Insurance Fraud:

The majority of healthcare fraud is committed by a very small minority of dishonest healthcare 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.

OUR REPORTS

Stryker has developed a simple but very specific interview technique. As such, our questions are structured around specific categories that include:
- Character Evidence – California Code Evidence Code Chapter 1. Evidence Of Character, Habit, Or Custom.
- Pre-existing Evidence – HIPPA-compliant medical release.
- Testimonial Evidence – Evid. Code § 701, 752, 754; Fed. Rules Evid. 604.
- Relevant Evidence – California Code Evidence.
- Real Evidence – Tangible objects, tools, equipment, etc.
- Factual Evidence – Facts that can be entered into evidence.
- Documentary Evidence – Evidence that represents or illustrates the real thing such as photos, videos, diagrams, maps, charts.

OUR VIDEO

All video evidence is obtained on HD video camcorders and streamed on Stryker’s secure servers and is available 24-7 on demand for our clientele