A medical specialist engaged us after discovering that fraudulent claims had been submitted in her name – over 1,100 services across a nine-month period. Despite acting quickly and in good faith, she received no support from her medical defence organisation or any other body.
Our first priority was to provide peace of mind by helping her make the appropriate notifications to relevant authorities. We then set to work, applying internationally recognised methodologies to analyse the claims. This involved identifying red flags in the billing data, then conducting a deep dive into the corresponding medical records. Fortunately, the doctor had a clear sense of where things had gone wrong and was able to guide our investigation. She was right – just about every trick in the book had been used.
We supported her throughout the entire process, including notification and repayment to Medicare, private health insurers, and affected patients. The total amount repaid was nearly $90,000.