Cost & Reputation Saving Health Care Fraud & Abuse Investigations

Fraud, waste and abuse can go undetected by an organization long before their most damaging effects are even seen. Detecting fraud, reducing loss and maintaining compliance requires an experienced team that is dedicated to helping organizations and litigators navigate the niche complexities of today’s health care industry.

Thorough Health Care Fraud Prevention Training and Planning

Managed care organizations, independent practice associations and medical providers operate in a complex landscape of compliance and regulation. We work with medical organizations seeking to reduce medical loss ratios, recover provider overpayments, recognize cost savings and achieve optimal operational efficiency, all while maintaining compliance with state and federal legislation.

Proactive approaches to preventing fraud, waste and abuse can save you time and money, but they are only effective if implemented with care and precision. We work with your organization to develop and implement corporate Fraud, Waste & Abuse (FWA) Compliance Programs, conduct tailored fraud awareness training and even assist in creating corrective action plans for recovering overpayments from providers and vendors.

Litigation Support, Every Step of the Way

Litigation stemming from regulatory and health care plan audits and inquiries can leave lawyers at a loss for how to navigate the niche complexities of today’s health care industry. For law firms, we provide independent examinations and coding reviews through proactive, on-site exposure analyses and offer mitigation strategies for any adverse discoveries. Our investigators assist in litigation arising from:

  • Medicare and Medicaid audits, such as audits emanating from a state’s Office of the Medicaid Inspector General (OMIG)
  • The U.S. Department of Health & Human Services Office of Inspector General (OIG)
  • A state’s Medicaid Fraud Control Unit (MFCU)
  • Zone Program Integrity Contractors (ZPIC)
  • A state’s Medicaid Integrity Contractor (MIC)
  • Criminal and civil investigations involving the Stark Law, anti-kickback laws, the False Claims Act, qui tam actions and other regulatory actions

You’re in Experienced Company

With a team of experienced investigators, auditors and forensic accountants, we detect fraud through data mining and meticulous reviews of records. T&M’s team is comprised of Accredited Health Care Fraud Investigators (AHFI’s) certified by the National Health Care Anti-Fraud Association, Certified Fraud Examiners (CFE’s) certified by the Association of Certified Fraud Examiners, Certified Public Accountants (CPA’s), Certified Professional Coders (CPC), clinical reviewers and former prosecutors and law enforcement executives who are recognized industry experts in their fields with extensive health care management and field operations experience.

Let's discuss your challenges and how T&M can deliver a solution that offers peace of mind.


Health Care Fraud & Abuse Team Contacts

Michael J. Mansfield, Esq.