Overbrook Consultants
Medical Fraud Analysts

Services

Our Services

Our Services


MEDICAL FRAUD

OUR GOAL IS TO ENSURE THAT OUR CLIENTS PAY WHAT IS OWED ON A CLAIM - NOTHING MORE BUT NOTHING LESS

  • Nurse Reviews
    • Chronology of events and treatment
    • Medical necessity of treatment based on Clinical Guidelines
    • Causal relationship of injuries to the incident in question
    • Proper use of CPT codes
    • Findings are then applied to all billing invoices
    • *Includes a Bill Review*
  • Peer Reviews
    • Medical necessity and relatedness of treatment is determined based upon the medical opinion of a peer
    • Peers findings are applied to the medical records
    • Proper use of CPT codes
    • Findings are then applied to all billing invoices
    • *Includes a Bill Review*
  • Bill Review
    • Used as a stand alone service when causal relationship and necessity of treatment are not being disputed
    • Evaluation of documentation and fees charged
    • Proper use of CPT codes
    • Directly relates the treatment and supporting documentation to the amount billed
    • UCR fees are geo-targeted for that specific area
  • We work with:
    • Third Party Administrators (TPAs) 
    • Risk Management for Self-Insured Companies
    • Insurance Companies - Casualty, Auto, Personal Injury/Bodily Injury
    • Attorneys

OPIOID INVESTIGATIONS

OUR PRIMARY GOAL IS TO SAVES LIVES - OUR SECONDARY GOAL IS TO SAVE OUR CLIENTS TIME

  • We provide a comprehensive review of medical records in order to make the determination as to whether or not the State Mandated Pain Guidelines were adhered to.
  • We analyze our findings across a sampling of patient records from an individual provider. 
  • We provide a detailed summary of each patient as well as a global assessment of a providers prescribing patterns.  
  • We work with: 
    • Drug Enforcement Administration (DEA)
    • State Departments of Health & Licensure
    • U.S. Attorney General's offices
    • Department of Justice  

SPEAKING & EDUCATION

WE BELIEVE THAT AN INFORMED INDIVIDUAL IS OUR COUNTRY'S FIRST LINE OF DEFENSE

  • We educate and empower individuals to take ownership of their health care expenditures and to be able to read and understand their medical bills as easily as they read the Sunday paper.  Some of the topics we touch on are:
    • How to interpret medical billing codes
    • How to recognize signs of fraud & abuse
    • What to do if they suspect medical billing errors