Fraud and Abuse Reviews
CHN team has vast experience in detecting and preventing overpayments due to fraud and abuse, incorrect coding and third party responsibility/liability.
CHN Fraud and Abuse Investigation team helps in:
- Preventing payment on erroneous claims
- Finding potentially fraudulent claims
- Recovering overpayment losses
The most important review processes include:
- Prospective Reviews which prevent overpayment on potentially fraudulent or aberrant claims
- Retrospective Reviews which includes expert evidence analysis, medical records review, and case documentation