SAS: Before Claims Fraud, What About Eligibility Fraud?

“When thinking about the topic of fraud, waste and abuse in health care, everyone tends to think first about the integrity of the way the claim is presented – what’s typically referred to as claims fraud,” said Julie Malida, Principal in SAS’ Security Intelligence practice. “We want to shift the conversation to talk about whether your plan is actually covering the people you think you’re covering.”

Before claims are even filed, are you rigorous in determining eligibility? How often do you