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White - Collar Crime
The defense attorney for a large, privately owned clinical
laboratory retained Sinaiko Healthcare Consulting, Inc. in
a white-collar criminal case involving allegations of billing
government programs for unnecessary clinical laboratory services.
The Sinaiko litigation support team was engaged to conduct
an independent audit of the laboratory's billing practices
and policies in order to offer an expert opinion about whether
fraud was involved.
There was a deliberate, three-stage approach to this assignment.
First, the Sinaiko team worked closely with a professional
statistician in order to determine the most accurate method
of obtaining a random sample of claims that had been billed
to government programs. Next, the team procured a random
sample of approximately 150 paid claims over a four-year
period.
The third stage of the assignment was a detailed review of the records extracted from the laboratory's files. The Sinaiko consultants identified the specific tests listed on the lab order forms, assessed whether or not there was clear indication that the physicians understood what tests they were ordering, and evaluated whether or not the lab orders supported the claims submitted to the government programs for services ordered, performed and billed.
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