Fraud hits everyone in the wallet.

Zenith’s Special Investigation Unit takes a proactive stance against fraud.

Our Special Investigation Unit (SIU) is staffed with trained investigators, many with years of law enforcement and prosecution experience. Claims where employees have lost time from work are screened by our SIU for potential fraud or abuse. Zenith’s goal is to find the truth—either by validating an injured worker’s claim or building a case against possible fraud or abuse. Knowing the red flags of fraud is one way to identify suspicious claims. While not proof of fraud, red flags identify activities that historically have proven to be indicators of fraud.

To help minimize the financial impact of fraud, Zenith's anti-fraud program is an integral part of our claims management process. Our program includes the following steps:

1. We review 100% of claims where an employee has missed time from work for potential fraud or abuse.
2. If we find one or more red flags in a claim, the SIU will begin an investigation to collect evidence.
3. When there is reason to believe fraud has occurred, the SIU refers the case, along with our detailed evidence, to state fraud agencies.

Since 2004, Zenith’s investigations have led to more than 160 arrests. District Attorney’s offices have recognized Zenith’s fraud investigators for their outstanding work.

Medical Provider Fraud and Abuse

Zenith employs a Complex Case Analytics Team to investigate medical provider fraud and abuse, a major factor in today’s escalating medical costs. Our investigators root out provider fraud by focusing on unusual patterns in:

• Upcoding and billing over state fee schedules
  
• Medications dispensed by doctors
  
• Provider licensing

Zenith leads the way in exposing fraud and uses every legal avenue to enforce its zero-tolerance policy. Zenith was the first workers’ compensation company to successfully sue a provider under California’s anti-fraud law.