CLINIC INSPECTIONS

Maya and Maya, Inc.'s clinic inspection team is comprised of former Medicare and State healthcare 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 due diligance 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 their work? Thatâ??s a fallacy in South Florida. Those supposed physician never examine or treat your CLAIMANTS or your INSUREDS. Who is treating them? A far less trained individual and you are 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 is really 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

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 is really 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 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

Every $2 million invested in fighting healthcare 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 says 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 off 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 says it's okay 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 okay to pad a claim to make up for premiums they've already paid. Insurance Research Council (2000)

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

Seven of ten Americans say workers' compensation 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 ten in 1997). Insurance Fraud Prevention Authority of Pennsylvania (1999)

Nearly 16 percent of Pennsylvanians say they're willing to receive bogus workers' compensation 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 ten 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)


People's Attitudes about Fraud

Fraud Losses & Costs

More than one of every three bodily-injury claims from car crashes involves 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 â?? 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)


Florida A2300340 - California PI26215 - New York 11000172738
Florida Association of Licensed Investigators Association of Certified Fraud Examiners National Council of Investigation and Security Services Florida Board of Certified Investigators John E. Reid & Associates Nine Lives Associates Private Investigator of California Association
International Association for Asset Recovery