Insurance Fraud Investigations Red Flags or Indicators of Fraud Medical Provider Fraud Canned medical reports and notes Errors of an obvious nature such as subject’s gender, race or age Diagnosis and treatment don’t match Clinic using a P.O. Box or mail drop Facility with several names Unprofessional letterhead or stationary/photocopied Referral to nearby medical testing or clinics Answering machine Treatment on weekends and holidays Clinic diagnoses knew problems The work comp and health insurance are both billed Same treatment over and over Multiple subjects from same loss Same diagnosis for all subjects Clinic is a good distance from subjects home Inconsistency of fees for various services Numerous treatments on same day Mobile diagnostic operations Excessive diagnostic testing Subject can not identify clinic Subject can’t explain treatment Personal Medical Injuries are subjective – soft tissues, sprains, headaches, psychological issues Psychological claims for Stress and Anxiety Claim is from previous injury Excessive recovery time Excessive Chiropractic treatment Excessive testing – MRI-NCV Excessive Therapeutic treatment – massages, acupuncture Subject shows no interest in getting better – doesn’t want tests Subject visit specific doctors immediately Subjects’ vitals are good –despite alleged long term inactivity Subject is over dramatic when describing injury Conflicting medical opinions Medical billings are billed on holidays and weekends Treatment includes prescriptions for controlled substances Variation in description of pain Private Investigator in Connecticut |

