Services for Private Health Insurers and Large Employers
Deploying our expertise and experience, Lo Tignov can work with the Special Investigative Units (SIU) of Private Health Insurers and self-insured employers to collaborate to recover improper payments. We work with your team to identify fraud schemes and prevent improper payments, thereby avoiding the “pay and chase” which often occurs. In this regard, we have developed proprietary approaches to identifying fraud and improper payments. We can:
- Educate and train your team on our methodologies for identifying fraud schemes
- Provide investigative research and services
- Support litigation efforts
Lo Tignov has developed a methodology to identify cases that can be filed under applicable statutes and regulations to include the False Claims Act, SEC and IRS Whistleblower statutes. Lo Tignov’s strength is both in its ability to identify fraud, complete an investigation and file complaints in an expedited manner by:
- Collaborating to identify and investigate fraudulent billings
- Assisting in the enforcement of your Regulations (i.e. Medicare or Medicaid)
- Recovering funds paid as a result of fraudulent billings and prevent improper payments
Lo Tignov has identified, investigated and brought to justice fraud schemes including:
- A company using kickbacks to induce healthcare providers to enter into exclusive purchasing arrangements
- Multiple companies that have illegally repackaged, misbranded and adulterated injectable drugs
- A company that submitted numerous false claims for unapproved new drugs, and drugs that were defective or otherwise compromised drugs
- Hospitals that have provided kickbacks to physicians in exchange for referrals
- Laboratories that have billed for unnecessary medical services
Resources Essential to Success
Our company has seasoned full-time dedicated staff of subject matter experts to include:
- Fraud investigators
- Medical experts
- Consultants with strong expertise in health care, government affairs, government contracting compliance and public accounting
Why is Lo Tignov mission so critical today?
Healthcare fraud and corruption cost more than just the improper payouts. The rippling effects of fraud and corruption in our health care system cost the nation about $68 billion annually. It increases health insurance premiums, unnecessary procedures, and overburdens the U.S. healthcare system. Each family in the U.S. pays $800 more in health care costs each year due to healthcare fraud.
Everyone from Executive Branch of Government to State Legislators and Members of Congress to Attorney Generals and the Department of Justice is looking to eliminate fraud and waste in government. Currently, the Department of Justice only intervenes is less than 15% of fraud cases in healthcare. Lo Tignov’s mission to expand the reach and scope of exposing fraud and recover improper payments.