A Challenging Internal Investigation into False Claims Act Violations
A Fortune 100 health insurance provider was pursuing an internal investigation involving potentially improper diagnosis practices undertaken by a wholly-owned provider group. The scope of the investigation included analysis of reimbursements processed across 20+ disease categories, potentially triggering False Claims Act violations. With 2.3M documents to review, it was unclear how the internal investigation would be completed within a constrained budget and timeline. Counsel reached out to Lighthouse for help.
Lighthouse Hands Counsel the Keys to a Focused, Efficient Investigation
A small team of Lighthouse information retrieval, legal, data science, and linguistic experts immediately began working with counsel to understand the specific allegations at issue, as well as catalogue the various sources of data that needed to be investigated. The team then designed and executed a battery of complex searches tailored to find instances of fraud or wrongdoing related to the allegations at hand. By staying in close communication with counsel, the Lighthouse team ensured that new search requirements and data sources were quickly integrated into the workstream to support fact development.
On a weekly basis, Lighthouse delivered a streamlined set of documents responding to counsel’s evolving theory of the case. These deliveries also included a detailed breakdown of the categories of documents identified each week, descriptions of relevant internal processes and policies, and flagging of high-priority documents of particular interest to counsel. Each delivery was distilled down to only the most inclusive, non-redundant versions of relevant documents. In addition to keeping pace with ongoing requests and deliverables, the Lighthouse team also re-executed previous searches to address waves of new data rolling in midway through the engagement.
A Faster and More Comprehensive Investigation Resolution
Over the course of five months, Lighthouse delivered approximately 4,500 documents for review—out of the 2.3 million document review set. The Lighthouse deliveries encompassed everything counsel needed to know in order to resolve their investigation—and nothing more. The team accomplished this precision through deep subject matter expertise surrounding the allegations and underlying issues at play, consistent and effective communication with counsel, expert topic-based searching, and additional proprietary data analytics to remove unnecessary duplicative content.
By the end of their short engagement with Lighthouse, counsel had developed a comprehensive understanding of the pertinent risk areas and confidently completed their investigation—on time and within budget.