Services
Document a loss
Support a claim
For carriers and employers
Service areas
Middle Tennessee
- Nashville
- Clarksville
- Murfreesboro
- Franklin
- Hendersonville
- Smyrna
- Spring Hill
- Gallatin
- Lebanon
- Columbia
- Brentwood
- Mount Juliet
- La Vergne
- Cookeville
East Tennessee
West Tennessee
Medical Fraud Investigation Support for Carriers and SIUs
Delator Claims Division provides field verification that supports medical fraud reviews by workers' compensation carriers, self-insured employers, third-party administrators, their special investigations units and counsel. Investigators confirm what can be seen and found in public. The review and its conclusions remain the client's.
- Coverage
- 95 of 95 counties
- Dispatch
- 24 / 7 / 365
- Metro response
- Under 60 min avg.
- Statewide
- 4-hour guarantee
What this service covers
A carrier's medical fraud review is mostly desk work: bills, treatment patterns, referral relationships. At some point the desk needs someone to go and look. Is there a functioning clinic at the address on the bills? Do the same few patients arrive together in one van? Does a referral source share a suite with the provider it refers to? Those are questions of physical fact, and a licensed investigator can answer them without touching a medical record.
This support is available only to payers and their representatives, not to claimants, patients or providers. Delator does not audit medical records or billing codes, does not access protected health information without proper authorization, and offers no opinion on whether treatment was necessary or appropriate. Investigators report what they observed and found. They do not state that any provider, patient or attorney engaged in fraud.
Questions a desk review cannot answer alone
- Several unrelated claimants are treating with one distant provider, and the SIU wants to understand how those patients are getting there.
- A treatment facility, a transport company and a medical supplier appear on the same claims and may share ownership or an address.
- Claimants report being directed to a specific clinic by someone who approached them shortly after the injury was reported.
- A pattern identified by the carrier's analytics team needs on-the-ground confirmation before the unit commits further resources to it.
- Counsel defending a group of related claims wants public-record research on the entities involved before written discovery goes out.
What field support covers
- Entity relationship research
- Public filings showing owners, officers, registered agents and addresses for clinics, transport services and suppliers, charted to show any overlap among them.
- Shared-premises check
- A visit to listed addresses to record whether separate businesses occupy one suite, share an entrance or signage, or use a mail drop.
- Patient transport observation
- Observation from public areas of vans or shuttles delivering groups to a facility, noting vehicle markings, times and number of occupants, without identifying patients.
- Voluntary claimant interviews
- When the client requests them, interviews in which claimants describe in their own words how they chose a provider and what a typical visit involved.
- Marketing and solicitation material
- Flyers, billboards, web pages and social media advertising directed at injured workers, captured with dates and locations where each was found.
- Field findings memo
- A memo answering each question the reviewing unit posed, with the supporting photograph, record or observation cited for every answer.
From request to delivered record
- RequestCall dispatch or submit the request form with the location, loss type and urgency.
- DeployDispatch assigns the nearest available licensed field investigator through the statewide network.
- DocumentPhotographs, video, measurements and factual notes are captured once the scene is safe to work.
- PreserveFiles are timestamped, organized and kept in their original form with a record of who captured them.
- ReportThe package is delivered securely to the requesting party, typically the same day.
Where fieldwork fits in a medical review
The reviewing unit owns the analysis. It decides which providers or claims deserve a closer look and what it needs to know. Delator receives a list of specific questions and a scope: which addresses, which entities, how many days. That division keeps protected health information where it belongs. In most assignments the investigator needs only a provider's name, an address and the dates of interest, not patient charts or bills.
If the client believes a particular document is needed for the fieldwork, it is the client's responsibility to confirm that sharing it is properly authorized. Delator's investigators do not ask clinic staff about individual patients, do not pose as patients, and do not enter treatment areas. Observation is limited to parking lots, sidewalks, lobbies open to the public and other places where anyone may lawfully stand.
Keeping observation separate from accusation
Unusual patterns in medical treatment frequently have ordinary explanations. A rural area may have one specialist, so many workers see the same one. A clinic may run a shuttle because its patients cannot drive after procedures. Related businesses may share an address for convenience. A field report that jumps to an accusation would mislead the client and be unfair to the people involved. Delator reports the fact and stops.
What the client receives is a dated, sourced record that a reviewer, an attorney or a regulator could check independently. Photographs show what was at the address. Filings are attached as retrieved. Interview summaries identify the speaker. With that foundation, the carrier, its SIU or the appropriate authorities can decide whether anything further is warranted. Delator covers all 95 Tennessee counties with its own licensed personnel and does not subcontract this work to unaffiliated firms.
This service is available to insurance carriers, self-insured entities, third-party administrators and the attorneys who represent them. Delator reports facts and observed indicators; decisions on coverage, liability, settlement and any fraud referral remain with the client.
It is not offered to policyholders or claimants, and Delator does not act as a public adjuster. Policyholders and claimants can request neutral scene documentation instead.
Common questions about this service
Who can retain Delator for medical fraud field support?
Workers' compensation carriers, self-insured employers, third-party administrators, their special investigations units and attorneys representing them. The service is not offered to claimants, patients or medical providers. Each assignment is defined by questions the reviewing party supplies.
Do your investigators review medical records?
No. Delator does not audit records, evaluate treatment or interpret diagnoses. Investigators work from non-clinical information such as names, addresses and dates. Any protected health information stays with the client unless sharing a specific item is properly authorized and necessary for the field task.
Will the report say a provider is committing fraud?
No. It will say what was observed and what public records show. Whether those facts indicate fraud is determined by the carrier, its SIU or the authorities. Delator does not apply that label to any provider, patient, attorney or business.
Can you interview patients about their treatment?
Only claimants the client asks Delator to contact, only voluntarily, and only as the client and its counsel direct where a claimant is represented. Questions cover non-clinical matters such as how the provider was selected and how visits were scheduled. Investigators do not approach patients at a clinic.
Available statewide, including
Every Tennessee county is covered. See the deployment map for typical response tiers by county.
Request documentation anywhere in Tennessee
Dispatch is staffed around the clock. For time-sensitive scenes, calling is fastest; the request form works for routine and scheduled assignments.