When a claim arrives with red flags, the decision isn’t just operational — it’s financial. Is it pay quickly and move on? Or is it invest in investigations to reduce the payment — or deny the claim entirely?
Some organizations treat this as a budget question:
· “Investigations cost money.”
· “We need to control expenses.”
· “Fast cycle time matters.”
All true. But it’s also incomplete.
Because the right way to compare investigate vs. don’t investigate isn’t cost vs. cost. It’s Incremental Net Present Value (NPV).
The incremental NPV asks a simple question. What value was avoided or recovered because of an investigation compared to what was saved if there wasn’t an investigation? Investigation isn’t an expense isolation it’s an investment decision.
“Not investigating” isn’t free
Skipping investigation can feel like savings because you avoid up-front costs; however, in reality “don’t investigate” when a claim has red flags often means paying inflated damages, paying unsupported treatment, paying when accountability is questionable and/or paying a claim that shouldn’t be paid at all.
Moreover, once a carrier is known for paying questionable claims many times, schemers notice, the pattern is repeated, and crime networks return.
The Incremental NPV lens (simple version)
Incremental NPV = (Value Avoided + Value Recovered + Future Loss Prevented) – (Cost to Investigate)
Value Avoided
The money you didn’t pay because investigation clarified the facts such as overstatement exposed, liability disproved, damages narrowed and/or coverage issues confirmed.
Value Recovered
The money returned or prevented from leaving because the claim was withdrawn, repayment was necessary, and/or settlement leverage was strengthened.
Future Loss Prevented (the quiet multiplier)
This is the part that may get disregarded because it’s harder to measure but often the biggest win.
A strong investigation can reveal repeat claimant patterns, provider/shop networks, coordinated activity between several parties, and/or copycat scammers. Stopping one bad claim isn’t the full value, disrupting the next three is.
Paying is easy. Paying correctly takes proof.
Sometimes when paying quickly, to some degree something may be missed, especially where AI generated documents, false narratives and organized rings make the claim look “ordinary.” Investigation is about evidence that makes a difference in negotiations, in claims denials and in litigation.
The bottom line
When red flags appear, the question isn’t:
“Can we afford to investigate?”
It’s:
“Can we afford not to?”
Incremental NPV gives you the cleanest answer: What you avoided or recovered because you investigated — versus what you would’ve paid if you didn’t.
Because skipping the investigation fee is not a win if it funds the wrong claim. Roman & Associates delivers evidence that holds up — when it matters most.