Fraud And Abuse Controls

Plan Sponsors Are Losing Money In Ways Never Before Realized!

      Extent of Losses

• 3% to 7% of all health care payments should not be paid

      Solution

The HCPC Fraud and Abuse program will:

• Collect and review data for all claims in excess of $50,000 and all claims in which fraud and/or abuse is suspected

• Audit suspected data at the request of the plan administrator or the client

• Use a special investigation team to address fraud complaints

• Negotiate with the provider identified to modify and correct the service or charge involved  

       The Sentinel Effect  

• Let them know you’re looking! It is no secret that providers are more cautious with their billing practices if they know tight controls are in place