Investigators Using Social Media to Bust Fraudulent High Schooler Healthcare Claims

April 1, 2021


The Pennsylvania Insurance Fraud Prevention Association (IFPA) recently published their 2020 annual report. While reading through it, were really excited to see some of the great work that the SIU investigators at Highmark did on a case involving a physical therapist.

With social media being as prevalent as it is, we often forget that our lives are open books. Everyone has a footprint. Public databases are for the scouring. Social media platforms show us what everyone does in their daily lives. There are numerous ways to learn a slew of information about people and their lives by just being creative. This was the case with the Highmark investigators.

These sharp minded investigators took to social media and identified the postings of high school athletes who were actively engaged in their respective sports and training, all the while purportedly having conditions that needed the care and treatment of the physical therapist. The therapist was submitting claims for therapy sessions when in fact, he was providing services that were not covered under the benefit plan. Well over $2 million was billed to Highmark, and over $1 million was paid.

Our retired OIG agents all talked about the “old days” when an agent would have to spend countless hours on surveillance to establish certain investigative facts. With the increase in technology, those countless hours become minutes. Geolocating, social media platforms and the like are all ripe for the picking. Although law enforcement has the ability to access some information that is not available to the general public, the investigators in SIUs can take a look at some of those public records to make some great investigative inroads. Kudos to Highmark for being innovative in your investigative thoughts.

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