How the Work Gets Done
A forensic engagement is not an audit run faster. It is a different exercise, conducted on different terrain, with a different deliverable. The five steps below describe how that exercise unfolds — from the first conversation through the last finding, and through what follows them.
The Process
Five Steps to Clarity
The Initial Conversation
A confidential discussion to understand your plan structure, your vendor relationships, and the questions that have surfaced for you or your committee. We assess whether a forensic review is warranted, what the scope and timeline would look like, and what we expect to find. No obligation. No cost.
Data Ingestion & Forensic Review
We take in your claims data, administrative records, and vendor contracts under documented chain-of-custody protocols. Our team applies a forensic framework — built to surface what disclosure was structured to omit — to identify anomalies, quantify losses, and trace the financial flows running through your plan ecosystem.
Findings
A documented record of every loss identified, the methodology used to quantify it, and the evidentiary basis on which the finding rests. Structured to be defensible in regulatory examination, actionable for fiduciary decision-making, and usable as the foundation of recovery.
Recovery
We pursue the losses identified — through direct demand to the administrator, negotiated remediation, regulatory engagement, and formal proceedings where the matter cannot be resolved otherwise. The forensic foundation is our work product. Carrying it through to resolution is our practice.
Ongoing Protection
After recovery, we work with you to put monitoring in place that prevents recurrence. Forensic check-ins on a defined cadence ensure that new practices, vendor changes, or regulatory shifts are surfaced before they become systemic losses.
Expectations
What to Expect
The process is structured to minimize disruption to your operations while maximizing the depth of the forensic record.
Timeline
Timeline varies by plan size and complexity. Initial findings are typically delivered within 60 to 90 days of data receipt. Full recovery timelines depend on the remediation path chosen and the cooperation of the counterparty.
The Report
A documented, audit-grade record of every loss identified, the methodology behind each finding, and the evidentiary basis on which it rests. Built to be read by fiduciaries, defensible in front of regulators, and admissible if the matter reaches court.
The Recovery
We pursue identified losses through direct demand, negotiated remediation, regulatory engagement, or formal action. We do not deliver findings and step away. The engagement runs until the matter is resolved.
The Aftermath
Post-recovery, we establish monitoring protocols that surface new exposure before it accumulates. Plans whose administrators have been examined once tend not to require examination twice — but the verification continues.
What We Need
Access to three to five years of claims data, vendor contracts, administrative service agreements, and pharmacy benefit documentation. We handle the request process and work within your existing vendor relationships without disrupting them.
Confidentiality
Every engagement is protected by strict confidentiality undertakings. All data is handled under chain-of-custody protocols. Findings are shared only where the client directs them to be shared — and with no one else, under any circumstance.
The map starts with the first conversation.
A confidential review costs nothing and obligates nothing. It is the only step that has to come first.