On average, medical expenses constitute about 65% of total workers' compensation benefits*. Many factors can drive these expenses higher. Zenith’s SIU targets one of those factors: medical provider fraud and abuse.
Zenith leads the way in exposing fraud and uses every legal avenue to enforce its zero-tolerance policy. And we mean it—Zenith was the first workers’ compensation company to successfully sue a provider under California’s anti-fraud law.
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
Learn how to spot red flags of healthcare fraud.
*WCIRB Summary of 12/31/2011 Insurer Experience