Healthcare
Volume VII of the Sector Coverage Series
For hospital general counsel, healthcare compliance officers, medical-practice risk teams, and independent investigators retained by systems, physician groups, insurers, and medical malpractice defense counsel.
Professional Reference Material
These playbooks are professional reference material intended for licensed investigators. They are not legal advice. Investigators are responsible for compliance with the laws of their jurisdiction and the specific requirements of their clients and cases.
The TALON Difference
Every playbook in this platform is built against TALON, the proprietary defensive-operations doctrine developed inside The Investigator's Desk over years of federal investigative practice.
Actor-model analysis
Reverse trace
Artifact mapping
evidence econstruction
“Subscribers receive the playbook; the proprietary model that produced it stays inside the platform.”
Healthcare, at a Glance
108
Investigative Playbooks
22
Categories
$227
Per Month
within 24-36h
Dispatch
The 108 Healthcare Playbooks
The full catalog is listed below by category. Each entry is a standalone playbook covering the case type named.
01 · Provider Billing Fraud and Upcoding
E&M upcoding investigation
Surgical upcoding and unbundling workup
Radiology and imaging upcoding workup
Emergency department upcoding workup
Behavioral health billing fraud workup
Modifier fraud investigation
02 · Phantom Patient and Identity Billing
Phantom patient billing investigation
Beneficiary identity theft workup
Deceased patient billing workup
Duplicate patient and MRN fraud workup
Physician identity impersonation workup
03 · Pharmacy Dispensing Fraud
Pharmacy dispensing fraud investigation
Compounding pharmacy fraud workup
Specialty pharmacy fraud workup
PBM audit response and workup
Long-term care pharmacy fraud workup
04 · DME Fraud
DME dispensing fraud investigation
Orthotics and prosthetics fraud workup
CPAP and respiratory DME workup
Diabetic supplies fraud workup
Wheelchair and mobility fraud workup
05 · Lab and Diagnostic Fraud
Clinical lab kickback workup
Genetic testing fraud workup
Toxicology and UDS fraud workup
Cardiac diagnostic fraud workup
Anatomic pathology fraud workup
06 · Telemedicine and Telehealth Fraud
Telemedicine prescription mill workup
Telehealth billing fraud workup
Telehealth kickback workup
Telehealth platform fraud workup
Cross-state licensing and telehealth workup
07 · Substance Use Disorder Facility Fraud
SUD facility patient brokering workup
SUD facility body-brokering workup
SUD facility billing fraud workup
SUD facility UDS fraud workup
SUD facility licensing workup
08 · Hospice Fraud
Hospice eligibility fraud workup
Hospice billing fraud workup
Hospice kickback workup
Hospice quality-of-care workup
09 · Home Health Fraud
Home health eligibility fraud workup
Home health OASIS fraud workup
Home health kickback workup
Home health face-to-face fraud workup
Home health quality-of-care workup
10 · Physician Kickback and Stark
Anti-Kickback Statute investigation
Stark law investigation
Physician compensation and productivity workup
Medical directorship fraud workup
EKRA (Eliminating Kickbacks in Recovery Act) workup
11 · Medicaid Fraud
Medicaid provider fraud investigation
Medicaid beneficiary fraud workup
Medicaid transportation fraud workup
Medicaid personal care attendant fraud workup
Medicaid HCBS waiver fraud workup
12 · Medicare Advantage Fraud
Medicare Advantage risk adjustment fraud
HCC coding fraud workup
MA marketing and enrollment fraud workup
MA supplemental benefit fraud workup
MA network adequacy workup
MA provider directory fraud workup
13 · Employee and Insider Fraud (Healthcare)
Employee embezzlement workup (healthcare)
Employee HIPAA violation workup
Insider PHI misuse workup
Employee drug diversion workup
Employee credentialing fraud workup
14 · Executive Fraud (Healthcare)
CEO/executive expense abuse (healthcare)
Executive self-dealing workup
Physician-executive misconduct workup
Compensation and intermediate-sanctions workup (nonprofit health)
15 · HIPAA Breach Investigation
HIPAA breach investigation (electronic)
HIPAA breach investigation (paper)
HIPAA insider snooping workup
HIPAA vendor/business associate workup
HIPAA phishing incident workup
HIPAA lost/stolen device workup
16 · Ransomware and Cyber Incident (Healthcare)
Ransomware incident response (healthcare)
Medical device cyber incident workup
BEC and wire fraud investigation (healthcare)
Health system data breach investigation
Vendor breach workup (healthcare)
17 · Medical Malpractice Defense Investigation
Medical malpractice defense workup
Never-event and sentinel-event workup
Wrongful death investigation (medical)
Failure-to-diagnose workup
18 · Elder Abuse in Facilities
Nursing home abuse investigation
Nursing home neglect workup
Assisted living abuse workup
Elder financial exploitation in facility workup
Elder sexual assault in facility workup
19 · Credentialing and Licensing Fraud
Physician credentialing fraud workup
Nurse credentialing fraud workup
Physician license fraud workup
NPI and provider enrollment fraud workup
20 · Regulatory Investigation (CMS/OIG)
CMS ZPIC/UPIC audit response workup
RAC audit response workup
HHS-OIG investigation response workup
DOJ investigation response workup (healthcare)
CIA and monitorship workup
State AG healthcare investigation workup
21 · Litigation and False Claims Act
False Claims Act qui tam defense workup
False Claims Act intervention response workup
Healthcare class action defense workup
Whistleblower retaliation defense workup
22 · Emerging Exposure
AI in clinical decision workup
Digital therapeutics fraud workup
Private equity healthcare fraud workup
Consumer genetic testing fraud workup
Where Healthcare Meets the Rest of the Catalog
Healthcare investigations regularly cross into adjacent sectors. The volumes listed below carry the framework and playbooks that most often surface alongside a healthcare matter. Tier 2 subscribers have access to every volume; the cross-references identify where to look first.
Volume II · Banking
Healthcare-lending fraud, medical-practice acquisition-financing disputes, receivables-financing matters
Volume XIV · Pharmaceutical and Biotech
Drug-diversion investigations spanning provider and manufacturer, off-label promotion overlap matters
Volume XV · Insurance
Medical-malpractice claims, healthcare stop-loss disputes, health-plan fraud investigations
Volume XIX · Real Estate
Elder-property exploitation matters intersecting with capacity and medical decision-making
Volume XXV · Religious Organizations
Faith-based hospital and hospice matters, mission-hospital operations investigations
Volume XXVI · Estate and Probate
Capacity and undue-influence matters intersecting with medical records and treating-physician testimony
What Ships & How
Two Documents Per Case Request
Operational Playbook
The doctrinal chapter: case overview, business and practice framework, investigative blueprint with step cards covering purpose, actions, output, restrictions, and gates, evidence considerations, interview strategy, report considerations, common mistakes, a tabletop exercise with worked answers, closing take, and the case-specific Client Communication Pack of email templates for every touchpoint from proposal through invoicing.
TALON Brief
The actor model for the case typology, the artifact map, and the reverse-trace sequence. This is the doctrine layer that tells the investigator not just what to do, but why those steps in that order, grounded in how actors in that typology actually operate.
Universal Forms
25 universal forms are provided separately as a one-time subscriber download.
Delivery Framework
Case requests → secure email
Dispatch → within 24–36 hours
Maximum → 3 playbooks / rolling 7 days
Monthly reports → scheduled delivery
Quarterly report → scheduled delivery
On-Demand Reports → separate purchase