An “injured” worker on disability was found to be working again, this time as a janitor for an office building. Five hours of surveillance video showed him exceeding his modified duty restrictions while working for his new employer. In a deposition, his testimony was contradicted by the surveillance video. When his primary treating physician and… Read More
Stories
Medical Provider Fraud: Inflated compounded pharmaceuticals uncovered
Criminal charges have been filed against the providers involved in the Landmark Medical scheme where kickbacks were paid to numerous providers for prescribing and dispensing compound creams with highly inflated prices. Our investigations resulted in Landmark filing a lien consolidation against our client, a claims administrator. With evidence demonstrating that Landmark had manipulated the NDC… Read More
Auto Fraud: Uncovering a non-covered driver
A claimant attorney reported the loss, stating the claimant was driving the insured vehicle when it was involved in a hit-and-run, head-on collision. Injuries to head, back, neck and arm were reported. Our investigation discovered not only the identity of the hit-and-run vehicle, but also that the driver was not listed as an insured driver… Read More
Auto Fraud: Running through the medical mill
The insured reported that she was driving her insured vehicle when another vehicle ran a stop sign and collided with her. She complained of neck, back and side injuries; her two children and another passenger were also injured. The investigation revealed several red flags and discrepancies: soft tissue injuries, medical mill provider involvement and evidence… Read More
Auto Fraud: PIP claim fraud for dummies – how not to do it
The insured took out a policy for his Jeep; three weeks later he removed the Jeep from the policy and added an older Honda. A month later, he reported that while driving the (now-uninsured) Jeep he was involved in a multi-car rear-end collision, with neck and back pain. Other passengers were injured, he said. Red… Read More
Auto Fraud: Nothing’s as it seems
The accident was reported by a friend, stating that the insured vehicle was driven by the insured’s brother when he rear-ended another farm tractor and trailer. The insured was in the vehicle and complained of a dislocated/fractured hip. Two more passengers were in the vehicle, one of whom was also injured. Our investigation revealed several… Read More