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
- Contract negotiation
Learn more about our
program integrity solutions.