Role of Private Investigators in Medical Canvassing

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In the last few years, complaints about medical fraud are increasing at an astounding rate. Medical canvassing is a method that is used to check whether the claim is legitimate or not. Generally, this method is used by the insurance companies, defence attorneys and third-party administrators to check on the disability or the automobile accident claims. They often take the help of the private investigation company in Toronto to find out the treatment details for an injury, understand the complexities, and check whether it might have occurred outside of the reported injury-related claims.

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What Is a Medical Canvass?

As the name suggests, it is a canvassing process which is conducted by a private investigator. In this process, the private investigators make telephonic inquiries at different medical facilities in a geographic radius surrounding the home of the claimant’s place of employment or home.

This may include a range of different medical facilities, like pharmacies, hospitals, pain clinics, urgent care facilities, chiropractic clinics etc. The detectives carry investigations to find out whether the claimant got any treatment from these clinics. Once the dates of the treatment are received, the detective compares them with the date of the accident to check whether the injury is legitimate or it simply stemmed from the pre-existing conditions that took place outside of the accident of the workplace.

Information Gathered By The Medical Canvass Providers

During the canvassing, detectives of the private investigation company in Toronto telephone the facilities and voluntarily offer pieces of information, like the name and the date of birth of the claimant. The hospitals or the health care providers can simply affirm if the claimant got the treatment at the facility or not. If they have, the health care professionals can then offer the dates of treatments in that facility and information about any upcoming appointment.

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However, you should know that whether the health care professional offers some or all of the information depends on the interpretation of HIPAA. While some of the medical facilities choose to provide the information voluntarily, others might cite HIPAA violations.

With a properly executed HIPAA release form, the private investigators can:

  • Determine if the treatment has occurred before the date of the accident.
  • Discover information about undisclosed treatments.
  • Check if the treated injuries are aligned with the vehicle accident or workplace injury.
  • Find out whether the claimant has lied about the prior medical treatments.
  • Check whether the claimants have a history of injury claims.

What About HIPAA and Privacy?

Even though HIPAA provides privacy protection to certain health care data, it does not apply to certain health information related to employment. However, some medical facilities will not provide the necessary information without the signed HIPAA authorizations form. That’s why while conducting the investigation, the medical professionals only ask for the information that is not covered by HIPAA.

As you can see from the above information, medical canvassing can be a powerful tool when it comes to insurance defense claims. A medical canvassing conducted by the experienced investigators of a private investigation company in Toronto not only reveals the medical information but also might offer an opportunity for surveillance.

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