Your Healthcare Focus

Fraud and Abuse Detection: Investigative Services Including Site Visits

Although many fraud and abuse detection models and algorithms report clear-cut overpayments, many require an experienced fraud investigator to determine next steps.

For clients who need this additional support, we can perform a detailed investigation. Our techniques include drill-down reports and provider profiling, researching additional data sources like social media and public records, beneficiary interviews and results of provider self-audits, announced and unannounced site visits, and medical record reviews.

In addition, our experienced fraud detection consultants can help with:

  • Prioritizing investigations by dollars identified, potential patient harm, etc.
  • Staff education
  • Demand letters
  • Development of watch lists
  • Lock-ins
  • Recoveries
  • Contract negotiation

Learn more about our program integrity solutions.