Investigations & Findings
My approach is based on professionalism, attention to detail, and a commitment to achieving outstanding results for each client
Potential Internal Fraud - Healthcare
This case was a complex internal investigation that required due diligence and efficient documentation preparation. Our detailed investigation helped the client identify the cause of the problem.
Problem
An external perpetrator took advantage of a weakness in a deposit account number confirmation process. Several cash transfers, numbering in the hundreds of thousands of dollars, were completed. Was there inside help?
Result
Thanks to our deep investigation and detailed finding, the client was able to identify a weakness in internal controls related to ACH transfer information confirmation. Happily, there was no internal collusion with the outside actor.
Serial suicide attempts - Inpatient psych unit
Two successful suicides and two "close calls" ocurred on a locked 40-bed inpatient unit of a large regional hospital. According to a law enforcement investigation, no one was found to be at fault. However, the families of 3 patients sued the hospital. FI were hired by hospital counsel to investigate the issue.
Problem
A review of the patient's medical records showed there was no immediately apparent/stated suicidality. Each patient had contracted for safety and the hospital staff performed the required 15-minutes safety checks on each patient. Hospital staff were baffled about how a patient could hang themselves using bed sheets and curtains given the 15-minute safety checks. The checks were well documented.
Result
We conducted a thorough document review and several interviews with hospital staff and any patients who were on the unit at the time of the attempts. We learned that the unit was mixed (both males and females), and that staff had "caught" patients being intimate. In order to discourage this behavior, staff altered the regular 15 minute bed check order from always doing beds 1-40 in order, to checking periodically in reverse order. We found that this resulted in some patients being "checked" every 30 minutes instead of 15 minutes. 30 minutes is ample time to attempt suicide using the materials available (sheets, curtains).
Billing Risk Management - Medicaid
Problem
Result
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