You might be surprised to learn that not all insurance fraud is uncovered because of a personal injury investigation, workers compensation fraud investigation, product liability investigation or a long term disability insurance fraud investigation. No, it’s not always the “patient” who is being investigated. Sometimes it is the medical care provider!
Not every doctor, physical therapist or chiropractor is committing medical insurance fraud, but some are. Investigators were called in regarding insurance claims coming in from a specific chiropractor. The insurance company noticed that the number of claims had significantly increased from this particular service provider and the services were long-term and fairly extensive. It was the change in the claim history and types of claims that triggered one of those “red flags” for adjusters.