Roig Lawyers’ data analytics practice is vital in identifying trends in litigation, medical billing and records, and structured data and for rooting out inconsistencies, suspicious activities, and fraud in insurance claims.
As a firm, we always look for different perspectives and approaches to help our clients—to improve our methods and expand resources in meaningful and forward-looking ways. That’s why, years ago, we began collecting and storing information about insurance claims from various sources in a database. Our objective was to one day find a practical application for our efforts.
That “one day” came when we developed proprietary software to meet our objective, and wenow offer it to clients as a powerful resource for scoping, managing, and resolving suspicious and disputed claims. Our team can download, scrub, standardize, and sanitize millions of rows of data to better understand and identify lawsuits—who’s filing them, why they are filing them, where they are filing them—and use that knowledge to benefit our clients.
With this tremendous resource, Roig Lawyers has implemented an efficient process to assure clients that we are not defending their cases with blinders (not that we ever did, but this is even better). We are constantly—literally—looking at the bigger picture.
Our data analytics team’s capabilities are exceptionally effective for spotting red flags and uncovering fraud.
Looking at data points from our internal records and outside sources, including the Florida Department of Health, Agency for Healthcare Administration, clinic licensing data, and police reports, among others, we get a 360-degree view of the industry. We can zero in on particular claim types to analyze historical details.
Our analysts can see the kinds, numbers, and costs associated with specific policy provisions, both industry-wide and within our client organizations. We can tap into data related to storm damages, claims, resolutions, or statistics on medical procedures and rehabilitation common to certain types of accidents. As we identify and track the data related to loss claims, we can compare and contrast them to the one or 1,000 similar claims in our clients’ portfolios to weed out fraud.
Patterns and Trends
With our technology, depth, and breadth of experience, we are well-positioned to spot patterns and trends. In many instances, we gain unique insights into serious problems in specific client mattersand alert clients before realizing they have an issue.
For example, we identify and investigate fraudulent claims and scrutinize all documentation available in a case to look for patterns of unnecessary medical treatment, false or forged signatures, fraudulent medical claims, staged accidents, and patient recruiting. For example, by tracking the frequency of medical billing, treatment codes, and known medical staff resources, our attorneys can alert carriers when billing patterns indicate the likelihood of fraud.
Further, our analysts can predict whether concentrations of fraudulent claims are temporary or continuing, and we regularly communicate these findings to clients. We also track upcoming but unfiled cases and alert clients to what’s in their pipeline so they can plan and prepare. Overall, our analyses can reduce the amount clients spend on claims in a meaningful way.
Our ability to provide actionable, verifiable data for short- and long-term planning is why we have many established client relationships.
Clients love the data we offer them. They’re getting insights they never had before. Clients can also access our online database with a username and password. Once logged in, they can run custom reports or choose to sort and review detailed data to find answers to specific questions at no additional cost.
Clients also appreciate our statewide coverage. We serve clients throughout Florida intentionally because we want to support their needs, whether cases are in Jacksonville, Miami, Pensacola, or elsewhere. Although we may assign a different office, attorney, or analyst to a matter, clients will always have that one lawyer they know, like, and trust at the helm. And every client team member will know you, your organization, and your objectives, ensuring a consistent experience across the board and across the state.