The Keoghs Healthcare Enabled Fraud Team is committed to helping its client’s combat claims layering via medical professionals by providing intelligence, validation, investigation services and practical claims handling guidance together with the development of overarching strategies.
We have a thorough understanding of the requirements of expert medical evidence and the duties of those who seek to give expert advice in civil proceedings and combine this with the use of relevant literature, care pathways and clinical guidelines to assess and, where necessary, challenge the opinions competency and methodology of those experts. The aim to reduce claims costs, change behaviours and uncover poor practise or outright fraud.
Keogh’s has uncovered a large number of cases where medical reports have been produced in doctors' names without their knowledge or where reports have been amended without their consent. This appears to be widespread across the industry and a “copy and paste” culture along with the electronic production of medical reports provides the perfect opportunity for the fraudster