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Disputes & Litigation

Resilicore’s complementary services takes a creative approach to litigation and arbitration support, finding cross functional solutions that are timely and aligned to our client’s legal strategy. We partner with all internal and external parties, counsels, and legal teams to collect the information needed to get results, whether it’s analysis to support a legal position or new facts to support our client.

Fraud Analysis

  • Fraud awareness training
  • Fraud and defalcation analysis
  • Fraud investigations
  • Financial statement fraud
  • Internal control review/fraud assessment

 

Theft And Unjust Enrichment Investigation

  • Finding hidden assets/hidden income
  • Employee theft and embezzlement
  • Retrieving and analyzing information from multiple data sources

Relevant Cases

  • High Technology - Pricing Strategy

    Client Situation

    Need improved pricing management and policy adherence to substantially increase profitability.  To avoid: Unilaterally resetting price points or administering discounts is difficult/impossible to undo

    Solution Provided

    • Provided an end-to-end solution supporting leading pricing strategy
    • Conducted an assessment of client’s current pricing process
    • Determined the level of adherence to this process
    • Compared client’s pricing process to other best-in-class companies

    Results

    • Designed and implemented a top-down pricing strategy process
    • Established tighter coordination between pricing and channel programs
    • Client experienced a 1% increase in margin at end of 6 months
    • Customer and Channel satisfaction increased 25% in first year
  • Insurance Plan - Fraud and Abuse Analysis

    Client Situation

    We were hired by a client to assist with the detection and quantification of fraud, waste and abuse related to a large selfinsured

    health plan. Our review focused on the Insurance Plan’s medical claims associated over a three year evaluation window

    Solution Provided

    • We assisted the client in detecting individual patients and medical providers that were likely perpetrators of fraud, waste and abuse.
    • This was done by integrating the Plan’s traditional fraud detection and internal audit procedures with advanced statistical and network analysis.

    Results

    • Discovery of fraud, waste and abuse in medical providers
    • Collusion of between patients and doctors for purposes of defrauding the Insurance Plan
    • Failure of health plan’s administrators to implement basic medical data, coding and medical necessity review procedures
    • Discovery of fraud, waste and abuse in the purchases of medical equipment