Medical Provider Fraud: A little too interconnected

Working with a claims management client, ISI obtained evidence of a chiropractor who was part-owner in several medical clinics and a law firm.

Further investigation found that a group of injured workers were all represented by the same law firm and consistently received the same treatment/referral patterns. The chiropractor had been indicted; however, the various providers weren’t included in the indictment. Several clients of the claims management company filed a lien consolidation against the providers; 12 agreed to a global withdraw and forbearance to avoid being named in the lien consolidation.

As a result of ISI’s aggressive pressuring and hand-selected defense counsel specifically trained in fraud litigation, SIU was able to resolve over $1 million in exposure for these 12 providers. Estimated savings: more than $1 million.