We confirm that the treatments you’re paying for were actually provided, and were provided to real patients by licensed medical professionals in a fully licensed facility.

At Kelley Alliance, we have various ways to detect clinic fraud. We perform clinic inspections, clinic surveillance, licensing verification, and medical bill review.

Clinic inspections are a great way to signal to providers that you’re watching their billing practices. In a clinic inspection, a Kelley Alliance investigator will visit the clinic and represent your company professionally and tactfully. We’ll confirm that the clinic is open for business, take note of patient traffic, and verify that the clinic’s licenses are legally displayed and up-to-date.

Our investigators will also perform room-to-room inspections. We’ll take note of how many rooms a clinic has to help determine its patient capacity. We’ll check equipment to make sure the clinic has the tools it needs to perform the procedures it’s billing you for. And we’ll comb through medical records, check patient signatures, and make sure they match the signatures on the patients’ drivers’ licenses.

We also surveil clinics to monitor their patient traffic. During a surveillance, we’ll record patient descriptions and vehicle license plates so we can match them to patient information. We’ll verify that patients are present and receiving treatment on the days you’re being billed for.

With our thorough investigations, you can be sure you’re not paying benefits for phantom patients or phantom procedures.

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FIELD INVESTIGATION

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BACKGROUND INVESTIGATIONS

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SIU SYSTEM MANAGEMENT

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VENDOR MANAGEMENT