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