Health Insurance Investigation
Your trusted partner in delivering accurate and impartial health insurance investigation
Discover Our Expertise
At Dream Forensic Services we specialize in medical insurance fraud investigations that protect insurance companies from fraudulent claims. With extensive experience in the industry of investigation, our team of experts conducts detailed investigations to ensure the of creditability of claims, helping the companies to maintain the integrity of their claims process while minimizing losses due to fraudulent activities.
Our Approach to Health Insurance Investigations
Health insurance fraud is a significant issue that results in millions of dollars in losses each year. Fraudulent claims can involve several forms of Frauds, such as miss-representation of details, double billing, mentioning unnecessary treatments, inflated charges, or falsified diagnoses. Our investigation services are designed to uncover any inconsistencies, ensure the authenticity of claims, and provide insurers with accurate, reliable information to make informed decisions.
Our investigation process involves the following steps
1
Data Analysis and Desktop Verification
We review the data which is provided by insurance companies and use our data to find red flags in provided claims. Also, we begin the desktop verification afterwards by reviewing all submitted documentation, including medical records, treatment history, hospital bills, and prescriptions. This step helps identify any discrepancies or areas of concern that require further investigation
2
Investigation of Disease Chronicity and Medical History
To ensure claims are legitimate, we verify the chronicity of the illness or injury for which treatment is being claimed. This includes a thorough review of medical history, previous treatments, and any pre-existing conditions that may affect the validity of the claim.
3
Hospital and Treatment Verification
We conduct on-site investigations at hospitals and clinics, verifying the nature of the treatment provided and checking the authenticity of hospital bills. Our team ensures that surgeries, medications, and other treatments are justified according to the patient’s condition and insurance policy terms.
4
Billing and Prescription Review
We examine billing details, ensuring that the charges match the treatments provided. This includes verifying the accuracy of prescriptions, medical services rendered, and any discrepancies in billing practices that could indicate fraud.
5
Patient Interviews and Statement Collection
Our investigators engage directly with the patient to gather additional information about their treatment. This includes interviews to confirm the nature of the complaint, the treatment received, and verifying the patient’s identity to rule out impersonation.
6
Hospital and Provider Background Checks
To detect any suspicious activities or fraudulent practices within the healthcare network, we investigate the background of hospitals and medical providers involved in the claim. This can help identify patterns of over-billing, unnecessary treatments, or collaborations with agents or intermediaries that may be exploiting the insurance system.
7
Medical Expert Review
Our team includes experienced medical professionals who conduct quality checks to ensure that the care provided meets the required medical standards. This review ensures that any claimed treatments align with established healthcare practices and guidelines.
After doing all the necessary verification and investigation we provide industry best reports to our clients with our opinion on the Investigated claim.
At Dream Forensic Science we are committed to ensuring that your health insurance claims should be properly investigate and so that we can help you making free from fraudulent activities. Whether you are managing cashless claims, reimbursement claims, or investigating possible fraudulent behavior within hospitals and medical providers, our team is ready to provide comprehensive support.
Let Our Forensic Experts Assist You
We’re here to provide the expert assistance you need for your forensic inquiries. Contact us to discuss how our expertise can help you navigate your forensic challenges
Frequently Asked Questions
What do you mean by Health insurance fraud?
It is a premeditated fraud or distortion by individuals, insurance organisations or health providers in order to attain fiscal and further benefits for which they are not legally entitled.
Why does the insurance industry require fraud investigation?
Fraud investigation aids the insurance industry to determine or address doubtful claims minimising monetary losses, sustaining functional integrity and also averting premium raise for policy holders.
How do insurance companies investigate health insurance claims?
Health insurance claims are investigated by insurance companies by reviewing all the submitted documents by policy holder and hospital and evaluate all billing and medical dossiers then cross-index it with insurance policy’s terms and discrepancies found if any, may result in rejection of the claim.
What is the role of an insurance fraud investigator?
Insurance fraud investigators examine claims, manage reviews and collect evidence to recognize and counter Health insurance fraud.
What are the warning signs of health insurance fraud?
Some of the common warning signs are repetitive claims for the same treatment or procedure, charging for expensive treatments which are not needed or never implemented, billing individually for operations to raise costs, and so on.
How much do you charge for insurance fraud investigation services?
Our charges depend on the case. For more information, kindly connect with us
What is the timeline for fraud investigation?
The timeline varies case to case. For more information, kindly connect with us.