CLINIC INSPECTIONS

	Maya and Maya, Inc clinic inspection team is compromised of former Medicare and State Healthcare care investigators. Our seasoned investigators have investigated and referred some of the most unscrupulous healthcare fraudsters in the South Florida area. We are experts in conducting a proper clinic inspection and performing the necessary task to determine whether your claims are valid or not. Why pay fraudulent claims? Do you know that many healthcare clinics in Miami only treat patients with licensed physician assistants and claim that a MD reviewed his work. That’s a fallacy in South Florida. Those supposed physician MD never examine or treat your CLAIMANTS and or INSURED. Who is treating them? A far less trained individual and your billed at the more expensive treatment rate when you received that Universal claim 1500 form. When you choose our agency we will not only go and perform the proper clinic inspection but we will also investigate the process of the treatment and who really is giving the treatments. We will determine if treatments were given at all and recommend the necessary actions and or possible criminal referral if necessary. Many South Florida healthcare clinics give “Incentives” to tow drivers, body shops, and or unscrupulous parties to get them to refer people to their clinic to perform post accident treatments.

The Usual Accident Scam: The supposed accident occurs and parties are referred by a runner and or others to accident clinics to receive treatments. When the claimant and or your insured arrives they are told they can get this for that. What does that mean? Very simple they get an incentive for coming for the clinic! You the insurance carrier get the bill! We here at Maya & Maya, Inc are here to help stop FRUDULENT INSURANCE CLAIMS! The inspection will include the following but is not limited to inspection of the facility, background of the owners, silent owners, healthcare workers, medical directors, review of medical file by our expert healthcare medical staff comprised of licensed Nurse Practitioners, possible EUO of the claimant, insured, interview of all medical staff on premises, review of all licenses.

In General...

The U.S. spends more than $2 trillion on healthcare annually. At least 3 percent of that spending — or $68 billion — is lost to fraud each year. (National Health Care Anti-Fraud Association, 2008)

Private health insurance
1. Every $2 million invested in fighting health-care fraud returns $17.3 million in recoveries, court-ordered judgments, plus bogus claims that weren’t paid and other anti-fraud savings. (National Health Care Anti-Fraud Association, 2008)

Slip & fall injuries

Swindlers will pretend to slip or trip and injure themselves to fraudulently collect insurance settlements or other payouts. Often the swindlers threaten an expensive lawsuit to extort fast payouts. Businesses are frequent targets.
1. Three percent of slip-and-fall injuries are fraudulent. (National Floor Safety Institute)
2. Bogus injury claims and related costs such as litigation amount to nearly $2 billion a year. (ibid)

People's Attitudes About Fraud

Consumers
Nearly one of four Americans say it’s ok to defraud insurers, says a survey by the consulting firm Accenture Ltd. Some 8 percent say it’s “quite acceptable” to bilk insurers, while 16 percent say it’s “somewhat acceptable.” About one in 10 people agree it’s ok to submit claims for items that aren’t lost or damaged, or for personal injuries that didn’t occur. Two of five people are “not very likely” or “not likely at all” to report someone who ripped of an insurer. Click here www.insurancefraud.org/accentureStudy03.htm for the complete study. Accenture Ltd. (2003)

Nearly one of 10 Americans would commit insurance fraud if they knew they could get away with it. Nearly three of 10 Americans (29 percent) wouldn't report insurance scams committed by someone they know. Progressive Insurance (2001)

More than one of three Americans say it's ok to exaggerate insurance claims to make up for the deductible (40 percent in 1997). Insurance Research Council (2000)

One of four Americans says it's ok to pad a claim to make up for premiums they've already paid. Insurance Research Council (2000)

One of three Americans says it's ok for employees to stay off work and receive workers compensation benefits because they feel pain, even though their doctor says it's ok to return to work. Insurance Research Council (1999)

Seven of 10 Americans say workers comp fraud is a widespread problem, and 45 percent say fraud is increasing. Insurance Research Council (1999)

One of five employed workers says they've been aware of fraud in their workplace. Insurance Research Council (1999)

Four of five Pennsylvanians reviewed their medical bills for accuracy in 1999 (seven of 10 in 1997). Insurance Fraud Prevention Authority of Pennsylvania (1999)

Nearly 16 percent of Pennsylvanians say they're willing to receive bogus workers comp payments (25 percent in 1997). Insurance Fraud Prevention Authority of Pennsylvania (1999)

Three of four Americans aren't willing to pay more for their auto coverage to allow bad-faith third-party lawsuits. Insurance Research Council (2000)

Physicians
Nearly one of three physicians say it's necessary to game the health care system to provide high quality medical care. Journal of the American Medical Association (2000)

More than one of three physicians says patients have asked physicians to deceive third-party payers to help the patients obtain coverage for medical services in the last year. Journal of the American Medical Association (2000)

One of 10 physicians has reported medical signs or symptoms a patient didn't have in order to help the patient secure coverage for needed treatment or services in the last year. Journal of the American Medical Association (2000)

Fraud Losses & Costs

Personal Injury Protection (PIP)
More than one of every three bodily-injury claims from car crashes involve fraud. Insurance Research Council (1996)

17-20 cents of every dollar paid for bodily injury claims from auto policies involves fraud or claim buildup. Insurance Research Council (1996).

Fraud adds $5.2-$6.3 billion to the auto premiums that policyholders pay each year. Insurance Research Council (1996)

Claims for bodily injuries under the Personal Injury Protection portion of New York's no-fault auto coverage rose 79 percent between 1999 and 2000, compared to 25 percent in all no-fault states. Insurance Research Council (2001)

Insurers increased auto premiums up to 25 percent for New York City in 2001. Insurance Information Institute (2001)

The average PIP claim is $7,950 in New York State — 47 percent higher than the national average. Insurance Information Institute (2001)

Fraud costs each insured driver in New York State $75-$115 per year. Insurance Information Institute (2001)

PIP claims in New York State rose nearly one third in 2000, more than twice as fast as second-place Florida. Insurance Information Institute (2001)

The average PIP claim in New York State jumped 19 percent over the first nine months of 2000, and 64 percent between 1995 and 3Q 2000. This compares to a 33-percent increase for other states. Insurance Information Institute (2001)

Auto insurers in New York pay out nearly twice as much in PIP claims as they collect in premiums. For every $100 auto insurers received, they paid $177 in claims through 3Q 2000. Insurance Information Institute (2001)

Licensed in Florida and California
Florida License:A-2300340		California License: PI-26215

Maya & Maya, Inc. are members of the following professional organizations.
Affiliations

Miami, Fort Lauderdale, Boca Raton, Key Largo, Key West, Orlando, Tampa, Bradenton, Hialeah, Miami Beach, Hallandale

CLINIC INSPECTIONS

The Usual Accident Scam:

Private health insurance

Slip & fall injuries

People's Attitudes About Fraud

Fraud Losses & Costs