Clinic Inspections with Medical File Review

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Clinic Inspections with Medical File Review


The files you receive from a medical provider and the files they keep on hand are sometimes very different. In person file reviews can yield tremendous pieces of information. The handwritten sticky notes in files that are not supposed to be seen by the insurance company, or the blank treatment forms with the insureds signature on them can all lead to help the insurance company make the best claims decision possible.

Your SIU will conduct a thorough clinic inspection at the medical Providers office either scheduled or cold call at your request. If it is a PIP claim, we will review the medical charts and photograph the file completely. As experience Insurance SIU investigators we know a lot of the patterns to look for in these files. We focus on patterns that are unusual. We will inspect and photograph the clinic and equipment to assure the provider has the equipment to support the codes billed. We will obtain copies of all licenses and verify their status with the state. A complete employee list will be made along with management structure and will include any disciplinary history. If a statement with the Doctor is needed please advise at assignment so the proper scheduling can be made.  Observation of the clinic coming and goings along with all license plates will also be obtained for one hour to help determine if the patients are there for a sufficient amount of time to receive the modalities being billed.

Clinic Inspection and 1 Patient $500

Additional patient file chart reviews $250 each