Protecting Your Practice: Internal Investigation for ASD Service Providers
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The Regulatory Siege: Why Trust is Insufficient
Stop the uncertainty. In an era of heightened regulatory scrutiny, "trusting" that your staff is compliant is not a strategy, it is a liability.
The Regulatory Siege: Why Trust is Insufficient
The rapid expansion of insurance mandates for autism services has led to a corresponding increase in fraud scrutiny. Federal bodies, including the Office of Inspector General (OIG), have aggressively targeted providers for billing irregularities.
For an agency director, the risk is multifaceted: from "Ghost Billing" and "Impossible Days" to systemic upcoding that can invite federal auditing and litigation. Roberts Investigative Services (RIS) positions itself as your proactive Risk Management Partner.
Forensic Billing & Compliance Methodology
We solve the visibility problem through forensic precision. We uncover the direct gap between billed hours and actual clinical records to expose errors while fully respecting professional privacy. Our B2B methodology includes:
- Forensic Billing Audits: We triangulate billing logs, clinical session notes, and verification data (GPS/EVV) to detect service-delivery discrepancies before a regulatory body does.
- Field Compliance Verification: For services provided in public or community settings, our Investigative Advocates provide real-time verification of staff engagement and safety protocol adherence.
- Deep-Dive Vetting: We move beyond criminal background checks to uncover patterns of negligence or boundary violations hidden in personnel histories.
The Attorney-Privilege Shield
By retaining RIS through your legal counsel, our investigative findings are protected under the Attorney Work Product doctrine. This ensures that if the audit uncovers unfavorable facts, they remain confidential, giving you the "Internal Affairs" protection needed to self-correct and mitigate liability.
Compliance FAQs for Providers
What triggers a Medicaid or insurance fraud audit?
Triggers include "Impossible Days" (billing >24 hours), "Ghost Billing" for absent clients, and "Cloned Notes" - where clinical documentation is copy-pasted across multiple sessions.
Can I legally monitor staff in community settings?
Yes. In public spaces like parks or libraries, there is no "Reasonable Expectation of Privacy" regarding visual observation. We use silent video to document employee safety and engagement without violating wiretap laws.
Secure Your Agency's Future
Don't wait for an OIG subpoena to find out your staff is non-compliant. Get the facts now.
Call: +1-888-772-7894