Healthcare / Insurance Fraud and Abuse

Healthcare fraud and abuse is one of the leading causes of lost revenue for our clients. 

For three decades, KTM has remained on the cutting edge in the fight against healthcare fraud by identifying and understanding the intricacies and challenges involved in the detection, investigation, and litigation of healthcare fraud and abuse matters. KTM has aligned itself with the insurance industry to aggressively combat healthcare fraud and abuse, and our attorneys have partnered with our clients to deploy a front-line, hands-on approach to fighting fraud.

Our attorneys have taken great strides to identify and develop a keen understanding of how healthcare fraud and abuse has developed and evolved in recent years. Our understanding of these schemes to defraud has allowed KTM to achieve significant recoveries and cost-savings for our clients. Beyond the more “traditional” types of healthcare fraud and abuse such as providing unnecessary services and billing for services not rendered, our attorneys have fostered a deep understanding of emerging fraud and abuse trends associated with layperson control of licensed healthcare providers, prescription drug compounding, bogus/fabricated diagnostic testing and toxicology testing, and prescription drug re-packaging. Using proactive, innovative, and creative approaches to these emerging—and costly—issues, KTM attorneys have achieved several favorable and cost-saving results for our clients, often without having to resort to costly litigation.

We at KTM have a keen understanding of how healthcare fraud and abuse infiltrates, endangers, and damages everyone—our clients, their customers, and the marketplace as a whole. We regularly partner with healthcare and other professionals to identify, investigate, and address healthcare fraud and abuse matters. Our deep understanding of relevant statutory and regulatory schemes concerning healthcare professionals and entities drives our ability to provide sound legal advice, and to deliver measurable results in addressing complex healthcare fraud and abuse issues.

Special Investigation Unit Litigation/Insurance Fraud

Fraud and abuse in the insurance marketplace exacts a heavy toll on insurers, their customers, and the general public. At KTM, we recognize our clients’ needs for aggressive representation in combating insurance fraud. Insurers regularly face attack from legislators, regulators, and policyholder organizations. Combating insurance fraud is an area where insurers can aggressively support the public interest by taking significant steps toward maintaining premiums at a reasonable level.

For three decades, KTM has worked closely with our clients to convey the importance of fighting insurance fraud through the identification, investigation, defense, and prosecution of false and inflated insurance claims. We have developed considerable experience in providing legal advice on the proper handling and disposition of claims involving healthcare fraud and abuse, policyholder fraud, claimant fraud, claim inflation, staged or fictitious accidents, and application/rate evasion fraud.

Our attorneys not only have extensive hands-on experience in representing insurers in fraud-related investigations and litigation, but also have substantive knowledge in emerging areas of the law where insurers need expert advice, including RICO and healthcare fraud and abuse. Our trial attorneys supplement their litigation experience with up-to-date knowledge of the current trends in insurance fraud detection, investigation, defense, and prosecution by regularly attending and presenting at seminars dedicated to fighting insurance fraud.

With over three decades of experience representing insurers in fraud-related matters, KTM has the necessary insight, knowledge, skill, and experience to effectively counsel our clients on a broad range of claims handling, coverage, investigation, litigation, and legislative matters.

Property, Fire, and Theft Losses

Claims involving arson, theft, misrepresentations, and concealment are another cornerstone of KTM’s practice relating to the identification, investigation, and litigation of insurance fraud matters. Our attorneys have extensive training and experience in detecting suspicious claims through early investigative techniques, which include acquiring testimony and evidence from insureds, claimants, and other involved parties. We regularly partner with claims personnel, SIU investigators, and outside consultants to evaluate and investigate claims where fraudulent conduct is suspected.

For three decades, we have developed and refined our practice to deliver high quality and cost-effective legal advice to clients faced with the submission of potentially fraudulent claims. We provide a broad range of services to our clients to ensure that fraudulent claims are identified, investigated, and denied. By conducting examinations under oath and witness statements, and by analyzing damage appraisals, financial statements, tax records and other evidence relating to fraudulent or exaggerated claims, we strive to ensure that our clients only honor legitimate claims. Based on our extensive experience in this area, we recognize the importance of involving legal counsel as soon as possible when facing suspicious losses or fraudulent claims. We at KTM stand ready to advise all of our clients on the thorough and proper investigation, handling, and disposition of suspicious losses and fraudulent claims.