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Public Sector Fraud
Fraud perpetrated upon government entities has a direct negative impact
on all taxpayers. The District Attorney’s Office has specially assigned
prosecutors who handle only those frauds committed within the public
sector. It is an innovative approach, which combines aggressive
investigation and prosecution with a comprehensive prevention program.
The prevention aspect involves prosecutors addressing groups of
employees regarding the benefits available for work related injuries while
at the same time describing the consequences of committing fraud.
Claim Mills
Organized workers’ compensation fraud involving doctors and lawyers
have been an ongoing problem, especially in Southern California. Fraud
rings have made a practice of recruiting people to file phony work injury
claims. The workers are sent to medical clinics or legal referral centers
(commonly known as "claim mills"), which in turn refer them to a doctor
or lawyer who is in on the scheme.
Regardless of the legitimacy of the original claim, many medical or other
health practitioners fraudulently maximize the number of medical reports
and referrals in each case to increase the number of billings. They may
also over bill or render unnecessary treatment.
Premium Fraud
Premium fraud occurs when employers fraudulently misstate the number
of employees or the nature of their work, such as reporting a roofer as an
office worker. Other businesses are part of the "underground economy"
and carry no workers’ compensation insurance. Under new California law,
the Workers’ Compensation Fraud Division can now prosecute the
uninsured employer.
Employer and Insurance Carrier Fraud
In this type of fraud, employers or employees of an insurance carrier will
make a false statement regarding a workers entitlement to benefits. The
statement is designed to discourage the worker from pursuing a
legitimate claim.
Applicant Fraud
These cases involve workers who fake an injury, lie about the extent of
their injury, lie by denying filing previous claims, fail to disclose a prior
injury to the same body part, claim a non-work injury is work related, or
illegally work while obtaining benefits. Surveillance tapes regularly
expose applicants who are fraudulent.
When we are assigned a workers compensation claim we constantly are
reviewing the claim for possible violations of state or federal law. In some
cases, a claimant may be committing certain acts in violation of criminal
and or civil statutes. When evidence of a crime is detected, we
professionally gather evidence in such a manner that a criminal case may
be presented for criminal or civil prosecution. In some cases our clients
assign us the claim with pre-knowledge that the claimant may be
committing fraud. Our assignment is to document the claimant’s
fraudulent activities. We are expected to completely investigate the
allegations. We gather evidence (verbal, written and video) on behalf of
our cliant.
Insurance Claims
We can uncover fraud for any type of insurance whether it is life, health,
auto, or casualty.
MSI is profoundly aware of the growing losses experienced by insurance
companies and self-insured firms through fraudulent and malingering
claims. To counter such trends, many companies turn to MSI for
investigations of questionable and malingering worker’s compensation
claims. We have the specialized experience and proven techniques to
effectively investigate claims. We begin through preliminary investigation,
followed by surveillance documented with admissible videotape.
MSI helps insurance companies, self-insured and third-party
administrators by obtaining positive identification of claimant,
investigating eligibility and restrictions adherence, conducting activity
checks and doing surveillance to determine post-accident activities.
Medical record research, financial and operating history round out our
investigation.
Fraud perpetrated upon government entities has a direct negative impact
on all taxpayers. The District Attorney’s Office has specially assigned
prosecutors who handle only those frauds committed within the public
sector. It is an innovative approach, which combines aggressive
investigation and prosecution with a comprehensive prevention program.
The prevention aspect involves prosecutors addressing groups of
employees regarding the benefits available for work related injuries while
at the same time describing the consequences of committing fraud.
Claim Mills
Organized workers’ compensation fraud involving doctors and lawyers
have been an ongoing problem, especially in Southern California. Fraud
rings have made a practice of recruiting people to file phony work injury
claims. The workers are sent to medical clinics or legal referral centers
(commonly known as "claim mills"), which in turn refer them to a doctor
or lawyer who is in on the scheme.
Regardless of the legitimacy of the original claim, many medical or other
health practitioners fraudulently maximize the number of medical reports
and referrals in each case to increase the number of billings. They may
also over bill or render unnecessary treatment.
Premium Fraud
Premium fraud occurs when employers fraudulently misstate the number
of employees or the nature of their work, such as reporting a roofer as an
office worker. Other businesses are part of the "underground economy"
and carry no workers’ compensation insurance. Under new California law,
the Workers’ Compensation Fraud Division can now prosecute the
uninsured employer.
Employer and Insurance Carrier Fraud
In this type of fraud, employers or employees of an insurance carrier will
make a false statement regarding a workers entitlement to benefits. The
statement is designed to discourage the worker from pursuing a
legitimate claim.
Applicant Fraud
These cases involve workers who fake an injury, lie about the extent of
their injury, lie by denying filing previous claims, fail to disclose a prior
injury to the same body part, claim a non-work injury is work related, or
illegally work while obtaining benefits. Surveillance tapes regularly
expose applicants who are fraudulent.
When we are assigned a workers compensation claim we constantly are
reviewing the claim for possible violations of state or federal law. In some
cases, a claimant may be committing certain acts in violation of criminal
and or civil statutes. When evidence of a crime is detected, we
professionally gather evidence in such a manner that a criminal case may
be presented for criminal or civil prosecution. In some cases our clients
assign us the claim with pre-knowledge that the claimant may be
committing fraud. Our assignment is to document the claimant’s
fraudulent activities. We are expected to completely investigate the
allegations. We gather evidence (verbal, written and video) on behalf of
our cliant.
Insurance Claims
We can uncover fraud for any type of insurance whether it is life, health,
auto, or casualty.
MSI is profoundly aware of the growing losses experienced by insurance
companies and self-insured firms through fraudulent and malingering
claims. To counter such trends, many companies turn to MSI for
investigations of questionable and malingering worker’s compensation
claims. We have the specialized experience and proven techniques to
effectively investigate claims. We begin through preliminary investigation,
followed by surveillance documented with admissible videotape.
MSI helps insurance companies, self-insured and third-party
administrators by obtaining positive identification of claimant,
investigating eligibility and restrictions adherence, conducting activity
checks and doing surveillance to determine post-accident activities.
Medical record research, financial and operating history round out our
investigation.
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