healthcare fraud and abuseHealthcare Fraud and Abuse

Our healthcare valuation experts have extensive experience in fraud investigations for various types of situations.  Some of the areas we have experience investigating include medical record reviews, revenue reports and assessing the legitimacy of supporting documents, documentation and coding. We are experts in assessing situations involving provider and patient kickbacks such facilities offering services to patients at a discount or billing a different service, so it is “covered” by insurance.    We are experts in assessing provider relationships and potential provider to provider kickbacks whether it is discounted lease space, physician services agreements, pay to play, and much more.


Common Situations

  • Billing for more services than capable in a work day
  • Billing for one code/service but another was provided
  • Billing for services not provided
  • Billing higher than usual and customary to out of network benefits versus lower when billing in network benefits
  • Document alteration
  • Duplicate billing
  • Embezzlement
  • Forgery
  • Improper coding – usually upcoding
  • Omission of modifiers for higher rate of reimbursement, results in lower or denied payment
  • Ordering services that are not medically necessary
  • Providing services that are not medically necessary
  • Unbundling services

Our Clients

  • Legal Counsel representing healthcare entities or Federal/Commercial Payers (Medicare, Medicaid, FBI, OIG, Blue Cross, etc.)
  • LTAC & Acute Care Hospitals and Health Systems
  • Surgery Centers and Urgent Care Centers
  • Physicians, Surgeons and Ancillary Providers
  • See other list of client type/healthcare verticals
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