CLINIC FRAUD RUNS RAMPANT

Clinic fraud is widespread, costing insurance companies and employers billions of dollars each year. The FBI cites massive clinic fraud in a recent report and regular news stories highlight the enormity of this type of fraud. According to industry experts, health insurance fraud amounts to $30 billion per year.  

ETHOS CLINIC INVESTIGATIONS

Ethos experienced investigators are experts in conducting thorough clinic investigations. Our team has  investigated hundreds of unscrupulous clinics and medical providers across the country. Ethos clinic investigations will help you answer the following questions:

• Is your claim valid or not?
• Does the clinic exsist or is it a mail drop or store front?
• Is your claimant showing up for the appointments that the clinic is invoicing you for?
• Is your claimant being treated by a licensed physican, a licensed physican assistant, or possibly someone without a medical license?
• Are you being billed for the cost of a physican when an assistant or non-licensed employee is actually conducting the treatment?
• Is the clinic involved with "runners", or unscrupulous parties such as tow truck drivers, body shops, or attorney's that receive incentives to send patients to the clinic?

WHAT WE DO

• Verify clinics physical location and inspect the facility.
• Verify all medical licenses of healthcare workers and medical directors.
• Conduct surveillance to determine number of individuals entering/exiting clinic.
• Review of medical files by our expert adjusters.
• Interview claimant, insured, and all medical staff on premises.
• Conduct full background checks on the owners of the clinic.
• Determine if treatment is actually being conducted and clinic has equipment that they are biling for.
• Investigate the process of the treatment and who is giving the treatment.
• Determine if there is fraud and potential criminal referral.