Ethos

This September marks the start of 𝐍𝐚𝐭𝐢𝐨𝐧𝐚𝐥 𝐏𝐫𝐞𝐩𝐚𝐫𝐞𝐝𝐧𝐞𝐬𝐬 𝐌𝐨𝐧𝐭𝐡. A reminder that natural disasters don't just damage property. They open a window for fraud. Stay safe and stay alert. 💙 #NationalPreparednessMonth

Nearly 𝟏 𝐢𝐧 𝟑 𝐡𝐞𝐚𝐥𝐭𝐡 𝐢𝐧𝐬𝐮𝐫𝐞𝐫𝐬 aren't testing their AI for bias. Utilization review is exactly where that gap gets tested. AI is already being used for utilization review in sorting documents, flagging outliers, comparing requests against ODG and ACOEM guidelines. What it isn't doing (or shouldn't be) is making the final decision. Keep swiping for a break down on where AI actually shows up in UR today, and the one question that determines whether it's a support tool or a liability: does a qualified clinician still hold genuine decision-making authority? Click here for the full read: https://lnkd.in/gT7W47Vy

Join the #1 Webinar Series in the Industry! Dean Winte, Director of SIU will be hosting our upcoming Medical Canvassing session for a practical look at Medical Canvassing! FREE Continuing Education Credit approved for Insurance Adjusters: AK, AL, AR, CA Ind, CA WC, DE, FL, GA, IA, ID, IN, KY, LA, MN, MS, MT, MT-WC, NC, NH, NH WC, NM, NV, OK, OR, OR WC, RI, TX, UT, VT-WC, WA, WV, WY National Credit: Nurse and CRC. Pending: CCM, CDMS Register today: https://lnkd.in/ebBgqFkU

A great week at WCI 2026! Thank you to everyone who stopped by, connected with our team, and learned what the future has in store! We’re grateful for the connections, conversations, and opportunities to learn and grow💪 Until next year Workers' Compensation Institute! #WCI2026

The 𝟐𝟎𝟐𝟓-𝟐𝟔 𝐖𝐨𝐫𝐤𝐞𝐫𝐬’ 𝐂𝐨𝐦𝐩𝐞𝐧𝐬𝐚𝐭𝐢𝐨𝐧 𝐈𝐧𝐝𝐮𝐬𝐭𝐫𝐲 𝐈𝐧𝐬𝐢𝐠𝐡𝐭𝐬 𝐒𝐮𝐫𝐯𝐞𝐲 𝐛𝐲 𝐑𝐢𝐬𝐤 & 𝐈𝐧𝐬𝐮𝐫𝐚𝐧𝐜𝐞 found that 𝟓𝟖% of respondents identified fraud, waste, and abuse detection as the top short-term application for AI. This blog will explore how artificial intelligence is being used in utilization review today and where regulators are beginning to draw boundaries around its role. Click below for the full break down or visit our learning center for more on AI and it's role in Utilization Review. #UtilizationReview

Don't miss Tom Donahue at the 2026 Workers' Compensation Institute Conference for three amazing sessions all about Workers' Compensation Fraud! Mark your calendars tomorrow, 𝐀𝐮𝐠𝐮𝐬𝐭 𝟐𝟔𝐭𝐡 and learn about the entire process of Workers' Comp fraud. 🕘 8:45–9:45 AM: Uncovering and Detecting Workers' Compensation Fraud 🕘 9:50–10:50 AM: Investigating Workers' Compensation Fraud 🕘 10:55–11:55 AM: Prosecuting Workers' Compensation Fraud Everything from uncovering and detecting fraud to prosecution phase.

𝐓𝐡𝐢𝐬 𝐢𝐬 𝐭𝐡𝐞 #𝟏 𝐖𝐞𝐛𝐢𝐧𝐚𝐫 𝐒𝐞𝐫𝐢𝐞𝐬 𝐢𝐧 𝐭𝐡𝐞 𝐈𝐧𝐝𝐮𝐬𝐭𝐫𝐲! Join SIU Director Dean Winte for a practical look at how medical canvassing helps verify treatment history and uncover prior care that may change how a claim is evaluated. This session will explore the basics of medical canvassing, including the best ways to communicate with providers, key HIPAA considerations, and how canvass findings can help adjusters make more informed decisions around compensability and claim direction.   Attendees will walk away knowing when a canvass makes sense, which providers are worth contacting, and why pharmacy records can sometimes be the part of the story everyone missed. FREE Continuing Education Credit approved for Insurance Adjusters: AK, AL, AR, CA Ind, CA WC, DE, FL, GA, IA, ID, IN, KY, LA, MN, MS, MT, MT-WC, NC, NH, NH WC, NM, NV, OK, OR, OR WC, RI, TX, UT, VT-WC, WA, WV, WY National credit: Nurse and CRC Pending CCM and CDMS

Join the team at the 𝟖𝟎𝐭𝐡 𝐀𝐧𝐧𝐮𝐚𝐥 Workers' Compensation Institute Conference this week! Visit booth #1015 for amazing swag and entertainment. Let’s talk about what's working (and what isn't) in detection, investigation, and prosecution right now. Catch our sessions, stop by, or just say hi! See you in Orlando. 

AI has dramatically changed what is considered a “𝐫𝐞𝐝 𝐟𝐥𝐚𝐠.” Creating a convincing fake medical record once required extensive knowledge of clinical terminology, billing codes, and provider documentation practices. Today, generative AI has dramatically lowered that barrier. With a simple prompt, someone can create treatment notes, disability certifications, or diagnostic reports that 𝐜𝐥𝐨𝐬𝐞𝐥𝐲 𝐫𝐞𝐬𝐞𝐦𝐛𝐥𝐞 𝐥𝐞𝐠𝐢𝐭𝐢𝐦𝐚𝐭𝐞 𝐦𝐞𝐝𝐢𝐜𝐚𝐥 𝐫𝐞𝐜𝐨𝐫𝐝𝐬. Click here for the full blog: https://lnkd.in/eQ_2ShRV

𝐖𝐂𝐈 𝐢𝐬 𝐚𝐥𝐦𝐨𝐬𝐭 𝐡𝐞𝐫𝐞! Join Tom Donahue at the 2026 Workers' Compensation Institute Conference for three sessions all about Workers Compensation Fraud! Whether you catch one session or all three, this is the kind of insight you don't get from a textbook. ✅ 3 Sessions 📆 8:45am–11:55am 🎤 Detect → Investigate → Prosecute See you there 💪 #WCI2026 #WorkersCompensation #InsuranceFraud #SIU