Our Service Offerings
Big data has become a given, especially in the healthcare industry. Patient and insurance data are difficult to manage, and are typically presented as a combination of structured and unstructured data (which are sometimes incomplete). This data contains key insights that can be used to provide pivotal support in litigation matters when analytics are properly applied. FTI Consulting’s Network Analysis team specializes in solving data issues using advanced predictive modelling and Bayesian methods to provide creative ‘out-of-the-box’ analyses to tell the most accurate data story.
Big data and Visualization go hand-in-hand. We transform difficult to manage structured and unstructured data, while preserving its integrity, into visualizations to quickly and efficiently identify data abnormalities and key trends. These visualizations can be used to identify fraudulent behavior between groups of people while also displaying complex data in easy to digest diagrams. Using these visualizations, we provide efficient and sophisticated techniques to crunch data and present simple, easily understood results. FTI Consulting’s Network Analysis team uses an array of visualization tools ranging from Tableau to D3 to provide insights needed to make a significant impact at the strategy table.
Social Network Analysis
Social network analysis maps and measures the relationships and flows between any type of connected entities such as people and organizations. Social networks play a big role in an organization’s business practices, and often, the success of a business idea depends on the network of information flows and knowledge interactions. Social networks are not just found within organizations, but also exist between them. For example, a doctor’s professional network will influence his drug prescription decision. Today’s world is more connected than ever and, to this end, FTI Consulting is constantly researching new algorithms, methods and metrics in applying social network analysis to business problems and opportunities.
FTI Consulting relies on a number of analytical methods, such as social network analysis and data visualizations, to detect fraud. We use our expertise to consolidate large disparate sources of data and perform rigorous analysis on the consolidated data to identify anomalies that help us detect fraud. For cases pertaining to the False Claims Act, our use of innovative techniques has revealed unexpected, yet systematic, relationships among physicians and other providers with respect to their common billing and claim submission patterns. These systematic relationships have been used in fraud detection and litigation proceedings to show the interconnectedness of fraud participants.
Healthcare Litigation & Audits
FTI Consulting provides payers, providers and counsel involved in litigation or healthcare audits consulting and expert testimony. Our Network Analysis team brings unique insights and solutions to these audit and litigation problems by being able to visualize and capture the complex relationships in healthcare data and allowing for solutions traditional analyses fail to capture. Typical applications have included developing or critiquing statistical sampling, class actions, UCR (“Usual, Customary and Reasonable”) and assisting in common types of healthcare fraud, including false medical certification, p-coding and unbundling, medical necessity, self-referrals, services not rendered, and prohibited services rendered.
Insurance Claims Analysis
FTI Consulting’s Network Analysis professionals work closely with general counsel members of major insurance companies and their outside counsel on random sampling techniques and complex damage calculations for purposes of settlement negotiations and expert testimony. Our Network Analysis team has also assisted with projects involving catastrophic reinsurance coverage, RMBS exposure and prescription drug coverage as well as assessing the systematic risk to a healthcare insurer for a large group of New York City employees. Network analyses have led to the discovery of previously unseen risks that were not captured in classical regression analysis.
FTI Consulting’s Network Analysis team assists companies, counsel and forensic accountants with investigations involving insider trading and market timing allegations. Typical analyses evaluate communications and trading patterns over time to determine if profitable trading is consistent with the allegations. Family members, friends and close affiliates are also analysed with respect to the specific timing of extra-normal returns from investments. We have designed financial models estimating the economic damages to shareholders caused by alleged fraudulent activity of insiders and rogue traders. These models take into account the network effects of the number of interconnected investors when estimating damages.
FTI Consulting’s Network Analysis team has extensive experience in designing statistical samples, developing complex extrapolation and benchmarking models, and evaluating achieved precision levels for clients in the healthcare and financial industries. We assist healthcare clients and lending institutions in areas such as addressing allegations of improper billing practices and quantifying financial accuracy measures using network analysis. The results of our network analyses have not only assisted in narrowing the scope of the sampling process, but have also assisted clients with focusing their due diligence reviews to certain departments, medical procedures, investments or loan types.
FTI Consulting works closely with teams of attorneys to design network analyses and sampling techniques to develop statistically reliable results for pre-class certification phases, class decertification phases and large multidistrict litigation cases. Our Network Analysis team has employed mass appraisal methodologies that utilize advanced techniques to control for factors affecting home prices such as square footage and utilized geotagging and spatial autocorrelation to improve the model’s performance for unobserved factors such as being close to an industrial site, playground or park.
Labor & Employment Litigation and Compliance
The FTI Consulting Network Analysis team specializes in preparing economic and statistical analyses for clients facing disputes and compliance actions, relating to wage and hour issues, class action, class certification, lost earnings and discrimination. Our team has deep labor and employment experience handling the ever-increasing size and complexity of HR, payroll, personnel and timekeeper databases quickly, and effectively utilizes our specialized network analysis to improve visualizations, statistical analyses and damage exposures that other more traditional analysis simply miss.