A fraudulent claim that goes unchecked is costly, disruptive, and can put your business at risk. Not only does it impact your operations, it can also increase claim costs with unnecessary medical and disability payments. This often results in a higher experience modification, which can raise your premiums for years to come.
Insurance fraud isn’t easy to spot, and business owners don’t always know what to look for. Fraud and abuse can be perpetrated by an employee, medical provider, lawyer, medical billing firm, or others. With providers, it can be done by completing excessive treatment and exaggerated billing.
Zenith aggressively uncovers and fights those taking advantage of our customers or their employees. We do it by analyzing lost-time claims, treatment, and billing for exaggeration and fraud – by both employees and providers. When an investigation indicates fraud, our in-house Special Investigation Unit (SIU) teams up with our claims and legal specialists to prepare and submit a detailed report for law enforcement agencies that investigate fraud. Over the years, the fraud cases we’ve submitted have led to hundreds of arrests and convictions.
(Note: Insurance carriers are required by law to report all incidents of suspected fraud. Decisions on whether to prosecute are the sole responsibility of the authorities.)
