HEALTH CARE FRAUD INVESTIGATION

Health care fraud is the intentional deception or misrepresentation that an individual or entity makes knowing that the misrepresentation could result in some unauthorized benefit to the individual, entity or another party. Often Medicare/Medicaid patients are unaware that their identity, insurance information and treatment is being used in a scheme to defraud.

What we do

Led by Dan James, one time Chief Investigator & Certified Fraud Examiner for the Office of the Federal Public Defender, Northern District of Texas, ICFECI’s team of healthcare fraud examiners investigate cases relating to

  • False billing, offering health care services without a license
  • False insurance claims
  • False diagnoses and unauthorized surgery
  • Forcing patients to undergo tests or surgery solely for pecuniary gains
  • Staged accidents
  • Kickbacks in patient referrals
  • Medicare/Medicaid billing schemes

What makes us Unique?

  • Dan James has 40 plus years of experience in fraud examinations and leads a team of experts with his insightful expertise.
  • We have the resources, the lab and the know-how to penetrate the complex payment systems and derive information that can be used as evidence acceptable in courts of law.
  • We know which records to examine and gather evidence references to legal implications and applicable laws.
  • Analyze data with computer forensics, carry out audits and investigate fraudulent claims in addition to putting our knowledge of equipment and drugs to question witnesses and gather evidence that is usually not obtainable through usual channels.
  • You will find us committed once we take on a case and we see it through right to the end.

We do face mighty challenges since we are up against established organizations that have access to legal counsel that can obfuscate evidence. We are up against a complex maze of electronic systems with encrypted data that may be spread across many locations. Regardless, we succeed.

Should you find yourself accused of health care fraud, get in touch with us and we will put our investigative engine to work to help you. It may also happen that you are wrongly accused of health care fraud. In this instance, it is even more of a priority that you retain us to carry out investigations and compile evidence that will tilt the scales in your favor and help you emerge with your reputation intact.