Crime Rings? Do you see a Pattern?


Everyday there may be a problematic workers’ compensation claim that lands on a desk. Weeding out the suspects to investigate can be a challenge, but even more thought-provoking –

Can any of these cases be connected?

When a development of factors occur that can link several cases together it establishes the possibility that there is a medical crime ring.

According to Risk & Insurance, many insurers rarely have enough data to confirm that a mass medical fraud operation is underway; however, an investigation can begin if there are observed connections within the cases.

Roman & Associates has the ability to investigate crime rings and has been able to provide our collected evidence to local district attorneys’ offices.

To appreciate how significant it is to flag mass criminality, each fraud ring has about 50 victims to include insurers and self-insured employers. Roughly $10 million is paid-out in losses for each case involved in a large medical provider con.[1]

Fraud health crime organizations are forever evolving to stay ahead regulations. According to the State of California’s Department of Industrial Relations, medical provider fraud can include the set-ups below:

  • Unnecessary treatments
  • Illegal Kickbacks
  • Soliciting
  • Fraudulent Billing and Billing Codes
  • Pharmacies providing generic drugs and billing for brand named prescriptions
  • Billing for medical equipment that was never dispensed[2]

To learn more about mass medical rackets or to assign a case you think may be involved with this type of scheme contact Roman today at


[2] https://www.insurancejournal.c...