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Stories

Work Comp Fraud: On-the-job “injury” provides paid time to work elsewhere

March 8, 2016

Knee Injury.

While lifting a heavy cabinet, the claimant heard his knee pop. An orthopedic doctor placed him in off-work status. Surveillance found him playing beach volleyball, with good range of motion and gait. He was also filmed purchasing construction supplies and offloading them at a home where he was building a deck. When interviewed by our… Read More

Categories: Uncategorized

Work Comp Fraud: Caught on tape

March 8, 2016

Security Camera.

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

Categories: Uncategorized

Medical Provider Fraud: Inflated compounded pharmaceuticals uncovered

March 8, 2016

Scanning a perscription.

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

Categories: Uncategorized

Auto Fraud: Uncovering a non-covered driver

March 8, 2016

Car Accident.

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

Categories: Uncategorized

Auto Fraud: Running through the medical mill

March 8, 2016

Neck Injury.

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

Categories: Uncategorized

Auto Fraud: PIP claim fraud for dummies – how not to do it

March 8, 2016

Backed Up Cars.

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

Categories: Uncategorized
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