Zenith takes healthcare fraud seriously as a company. Zenith’s anti-fraud program is housed under its Special Investigation Unit (SIU). The SIU focuses on the identification and investigation of fraud involving injured workers and employers.

A special team within SIU called the Complex Case Analytics Team conducts analytical data reviews to detect patterns or activity that are indicators of fraud. This includes medical treatment and billing fraud; transportation fraud; fraud involving interpreters; patient brokering (capping); and complex investigations outside of the "normal" SIU responsibilities. If fraudulent activity is suspected, our investigators will investigate the suspected fraudulent activity.

While most employers, workers and providers do not become involved in fraud, it is important to be aware that fraud occurs. Providers or billing offices may be drawn into a fraud scheme though the practices of office staff, external billing entities or professional recruiters (a person who recruits individuals to obtain services in exchange for a payment or other reward). As a provider, it is important to be aware of what is happening within your office, offices with which you are affiliated with, and any vendors you utilize for billing services.

Medical fraud and abuse does not just hurt the workers' compensation system—it can hurt the injured worker and you.

If you have been approached to participate in an insurance fraud scheme, or suspect fraud or abuse, please contact Zenith’s Complex Case Analytics Team Manager at (818) 594-5184 or email us at HIT@thezenith.com.