RiskTech Forum

SAS: Combating Health Care Fraud

Posted: 18 March 2010  |  Source: SAS


State-of-the-art methods for detection and prevention of fraud, waste and abuse in the health care industry.

Upcoding of evaluation and management services rendered during an office visit… unbundling of lab services that should be billed using a single lab-panel code… loaning a health insurance card to a family member not covered by the plan …submitting medical charges for nonexistent conditions or unnecessary procedures.

It’s all small potatoes, a victimless crime, fair compensation for spiraling premiums,deductibles and negotiated, lower reimbursements to health care providers formanaged care, right?

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