Workers' Compensation Provider Fraud
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The diagnosis is inconsistent with treatment. Medical treatment is protracted, even though the accident was minor. Beware if the claim is for an auto accident, and there is very little physical damage to the vehicle.
The doctor's report appears identical to other reports received from the same doctor or clinic.
Claimant/Doctor Report Inconsistent
Treatment reported by the claimant is inconsistent with the doctor's report.
Payment Accepted By Both Parties
Insurance and health carriers billed simultaneously. Billing claimants for services while receiving benefits.
Summary medical bills are submitted without date, descriptions of office visits and treatments, or treatment extends for a lengthy period of time without interim bills. The medical bills submitted are photocopies of originals.
Extensive treatment, especially for minor or subjective injuries; extensive x-rays, tests or diagnostic treatments.
Treatment directed to a separate facility in which the referring physician has a financial interest.
Medical services billed on Saturday, Sunday or Holidays.