Insurance fraud and health/benefits fraud cost insurance companies hundreds of millions of dollars each year. The Investigators Group works extensively with claim examiners, adjusters and legal specialists to help investigate and assess claims. Our services include investigation into fraud related to medical treatments, workers' compensation, life and health investigations, accident benefits investigations and property & casualty claims.
The Investigators Group's licensed private investigators are the most highly skilled in the industry. We have assisted clients with specialized investigations including undercover investigations and our professionals are adept at utilizing skilled investigation techniques including surveillance, video and photography evidence, witness interviews and statements. Our professionals are industry specialists who understand the need for integrity, confidentiality, and continuity within an investigation.
We have experience with complex investigations and those requiring multiple investigators. We are able to conduct background checks and have the ability to leverage multiple resources as needed.
IGI Uncovers Medical Services Fraud
Investigations to uncover organized insurance fraud requires the skills of experienced and skilled investigators. The Investigators Group assisted in one such investigation and our licensed private investigators were tasked with identifying fraudulent practices and illegal schemes at certain health care clinics. During the course of the investigation which spanned several months, our investigators uncovered kick-back and referral schemes of concern and unethical practices of the clinic, its staff and management. Ultimately, The Investigators Group helped to expose a fraud that netted the fraudsters over $1 million per year.
The Investigators Group Inc. has a number of senior investigators trained in conducting Health Care Provider Audits and Clinic Inspections. Such investigations will determine the legitimacy of Medical / Chiropractic facilities, verify licence status, identify practices and treatments and verify the relationships between the clinic, it’s employees and it’s management.
During the course of this type of investigation, investigators will often uncover over utilization schemes, illegal treatment, unlicensed providers and illegal ownership. The Investigators Group is committed to providing the best “Investigative Solution” utilizing Audits and Inspections where billing for service not rendered, treating outside the scope of practice, and kick-back or referral schemes are of concern. Contact us to learn more about how Provider Audits and Clinic inspections can provide you with the “Best Evidence”.
At The Investigators Group Inc. we take an in-depth statement from the claimant, inclusive of over 200 questions relating to the accident, passengers, claimant injuries and any related expenses including housekeeper, caregiver and transportation. Included in this comprehensive statement, are questions regarding employment, other sources of income, tenancy and information about dependents. Also examined, are the claimant’s normal physical and social activities, information regarding previous accidents and AB, BI, long term and short term disability claims and pre-injury physical capabilities. The statement is designed to identify occasions when claimants are not truthful.
Life & Health
• Comprehensive Surveillance • Claimant Interviews • Death Claims • Accidental Death
The Investigators Group has developed an objective in-depth claimant statement including lifestyle determinant, and relevant psychological questions where applicable. The statement is signed to identify situations in which the claimant may not be truthful and may be used in comparison to any surveillance undertaken
A licensed private investigator is trained in investigative techniques and must understand the procedural steps required to be followed in order for video surveillance to be admissible.
Employers can conduct surveillance using tools such as a swipe-card system, which data can be used for time-management and disciplinary purposes, or cameras.
I have seen first-hand how fraud can be harmful to a company’s reputation and brand. Engaging in a fraud investigation is difficult and can erode the trust and morale of employees and raise questions and concerns to your outside relationships, customers, suppliers and even prospective employees. That is why before engaging in any investigation, I will ensure that I explain to the client the investigation process, the potential scope and risks, and care is taken in planning the execution and timing of any investigation.