Selected Case Types

Methodology

Our proven hardware and software approaches scale easily to meet the requirements of multi-terabyte data sources and deliver valuable data intelligence by rapidly analyzing, correlating and mining large and complex data sets from vastly different sources.

The following list represents a sample of the types of cases we have supported or are currently supporting. Click the links below to learn more or contact us directly for case specifics and other details.

Case Details

  • AWP drug over-pricing
    • Integrate defendant and wholesaler transaction data to determine “but-for” prices
    • Perform claim-by-claim re-adjudication, overpayment calculations, and extrapolations on hundreds of millions of Medicaid and Medicare claims
    • Contribute to expert and rebuttal reports
    • Top – Contact Us

  • Best price violations (bundling)
    • Develop alternative bundling models
    • Construct bundles using defendant transaction data
    • Unbundle to calculate “but-for” best prices and “but-for” unit rebate amounts
    • Apply “but-for” URAs to utilization and calculate damages
    • Top – Contact Us

  • Best price violations (line-item pricing)
    • Identify “but-for” best prices in defendant transaction data and calculate “but-for” unit rebate amounts
    • Apply “but-for” URAs to utilization and calculate damages
    • Top – Contact Us

  • Diagnostic radiology/diagnostic testing
    • Perform peer review and other statistical analyses
    • Identify changes in behavior patterns over time associated with significant events (acquisition, sale, investigations, etc.)
    • Calculate damages
    • Top – Contact Us

  • Durable Medical Equipment
    • Analyze defendant accounting, transaction, tracking, and shipment data to identify falsified doctors’ orders
    • Calculate damages
    • Top – Contact Us

  • Federal contractor
    • Integrate defendant accounting, credit card, timekeeping and other data sources to reconstruct Public Vouchers (invoices) submitted to the federal government
    • Analyze and quantify internal inconsistencies
    • Top – Contact Us

  • Federal grantee
    • Analyze defendant transaction data to identify and characterize misuse of federal funds
    • Analyze defendant accounting data to identify additional areas of grant non-compliance
    • Calculate damages
    • Top – Contact Us

  • Home Health Agency
    • Integrate government claims data and third-party audit data to estimate volume and costs of services not meeting home-bound and/or medical necessity standards
    • Calculate damages
    • Top – Contact Us

  • Inappropriate hospital admissions
    • Analyze billing patterns, lengths of stay, and other factors associated with inpatient, outpatient, and emergency department claims
    • Calculate damages
    • Top – Contact Us

  • Inappropriate surgical procedures
    • Analyze relevant, comprehensive national data and complete patient claim histories to identify potentially inappropriate procedures
    • Identify outlier hospitals and systems
    • Quantify potential damages
    • Support statisticians, medical experts, and chart reviewers
    • Top – Contact Us

  • Kickbacks (physician/hospital)
    • Identify patterns and relationships evident in physician/hospital claims data
    • Identify changes in patterns and relationships over time
    • Calculate damages
    • Top – Contact Us

  • Kickbacks (pharmaceutical manufacturer/physician)
    • Integrate defendant accounting and government claims data to identify, characterize and quantify changes of behavior related to payments and other inducements to physicians
    • Calculate damages
    • Top – Contact Us

  • Medical transportation
    • Analyze claims data to identify inconsistent or impossible services
    • Identify outlier providers
    • Calculate damages
    • Top – Contact Us

  • Off-label prescription marketing
    • Develop models to identify a variety of off-label mechanisms, including high dosing, claims of superiority, unapproved uses, and unapproved combinations of drugs
    • Calculate damages
    • Top – Contact Us

  • Part D prescription drug benefit
    • Identify and re-price incorrectly billed drugs
    • Perform claim-by-claim re-adjudication of Prescription Drug Event data and re-apportion corrected prices among payors
    • Calculate damages
    • Top – Contact Us

  • Pediatric dentistry
    • Analyze Medicaid data to identify and characterize age/procedure/quantity inconsistencies
    • Calculate damages
    • Top – Contact Us

  • Physical therapy
    • Identify outlier behavior
    • Identify up-coding
    • Extrapolate damages based on error rates
    • Top – Contact Us

  • Services not rendered
    • Integrate defendant claims, appointment, and accounting data to identify improbable daily procedure quantities
    • Calculate damages
    • Top – Contact Us

  • Software manipulation
    • Analyze changes to source code over time
    • Perform automated regression testing to identify impact of changes over time across many parameters
    • Identify thresholds and boundaries of expected results
    • Top – Contact Us

  • Unbundling
    • Identify outlier behavior
    • Identify and quantify patterns of billing over time to establish baseline behaviors
    • Calculate damages
    • Top – Contact Us

  • Up-coding (diagnostics and physician services)
    • Quantify and characterize anomalous billing patterns
    • Identify trends over time
    • Calculate damages
    • Top – Contact Us

  • Up-coding (DRG)
    • Identify outlier behavior
    • Identify and quantify causality relationships between admission diagnoses and DRGs over time
    • Establish peer norms
    • Calculate damages based on causality and peer norms
    • Top – Contact Us