Fraud Investigations
Fast action and solid analysis get you back on track.
When you’ve experienced any type of financial fraud, time is of the essence. Our Fraud Investigations specialists help businesses, attorneys and others quickly conduct detailed investigations and stop the loss, enabling management to concentrate on keeping the business running. From assisting with complex internal investigations to sophisticated insurance claims analysis, we have the expertise to pinpoint the wrong-doing and reconstruct what happened.
The advantage of working with Fesnak fraud specialists is our extensive certification and specialized knowledge. In addition to CPAs, our team includes various specialties in the fraud area including Certified Fraud Examiners and training at the American Colleges of Forensic Examiners Institute. Of course, our Fraud Investigations unit also has ability to quickly pull in other service lines of the firm for any specialized knowledge required.
Typical projects include:
Fraud prevention services
In addition to our incident response services, our team also offers proactive services including fraud risk assessments, internal control and protocol enhancements and fraud monitoring activities.
When you’ve experienced any type of financial fraud, time is of the essence. Our Fraud Investigations specialists help businesses, attorneys and others quickly conduct detailed investigations and stop the loss, enabling management to concentrate on keeping the business running. From assisting with complex internal investigations to sophisticated insurance claims analysis, we have the expertise to pinpoint the wrong-doing and reconstruct what happened.
The advantage of working with Fesnak fraud specialists is our extensive certification and specialized knowledge. In addition to CPAs, our team includes various specialties in the fraud area including Certified Fraud Examiners and training at the American Colleges of Forensic Examiners Institute. Of course, our Fraud Investigations unit also has ability to quickly pull in other service lines of the firm for any specialized knowledge required.
Typical projects include:
- Asset misappropriation
- Employee embezzlement
- Bribery and corruption
- Intentional misrepresentation of financials or data
- Missing assets
Fraud prevention services
In addition to our incident response services, our team also offers proactive services including fraud risk assessments, internal control and protocol enhancements and fraud monitoring activities.
Representative Cases
SENIOR HOUSING ORGANIZATION
PHARMACEUTICAL FIRM
RETAIL PHARMACY
MEDICARE
SENIOR HOUSING ORGANIZATION
Directed a comprehensive fraud investigation on behalf of a premier owner and operator of senior housing in the Mid-Atlantic region. The company alleged that a Business Office Manager at one of their facilities was embezzling cash receipts. The investigation focused on the lapping and misapplication of payments received from Medicare, Medicaid, commercial insurance and self-pay. It culminated in the quantification of the scheme and recommendations for improvements in internal controls.
PHARMACEUTICAL FIRM
Assisted counsel for a global pharmaceutical firm in its response to a Medicare fraud investigation alleging manipulation (“unbundling” and “upcoding”) of CPT codes to maximize reimbursements for various laboratory test profiles.
RETAIL PHARMACY
Directed an internal fraud investigation and operational control review following the theft of cash and Schedule II controlled substances at a retail pharmacy. Following the investigation, recommendations were made to curtail future diversions including restricted access, prescription review and confirmation, improved inventory monitoring and regulatory reporting.
MEDICARE
Assisted counsel in settlement negotiations with the U.S. Attorney’s Office following the management of a comprehensive Medicare fraud investigation on behalf of a large teaching hospital. The government had alleged substantial Medicare claims reimbursement for the fraudulent supervision of resident physicians.