The Case of Insurance Fraud

Sometimes, big corporations hire me to find out how they customers are taking advantage of them. It’s always interesting how these companies, in return, try to squeeze every penny out of the people they serve. Anyway.  

A big health insurance company came to me about a woman who recently had had hip surgery. They believed that she was asking for more physical therapy appoints that she actually needed, according to their estimates. They asked me to do some digging to see how she is actually doing and prove she doesn’t need the appointments. I think they were thinking that the woman was actually doing really well, running marathons, and using the PT appointments to get back into shape.  

I schedule some appointments myself at the same clinic and had to go a few times before I actually saw the woman. Six months after her surgery, she was still on crutches. As it turns out, a freak bus accident, reinjured her hip and she had to have more PT to get back to health.  

In this case the insurance company was wrong about suspected fraud and needed to keep paying the woman.