Medical Fraud Review
Healthcare insurance fraud accounts for an estimated $100 billion in annual costs to American insurers, consumers and taxpayers every year. AllMed's mission is to reduce these costs, while making sure members get the benefits which they deserve, every time.
AllMed helps insurance payor SIUs, law enforcement agencies and service providers to detect and prevent provider & claimant fraud, while saving you money and time. Our Independent Medical Review services get to the heart of the medical evidence in every case, through detailed review of patient medical records.
With over 300 board certified physician peer specialists in active practice, we can quickly apply expert medical knowledge, to help you eliminate the following types of fraud and abuse, by answering the following questions
- Medical Necessity: Are the patient's symptoms really supported by the medical evidence in the chart?
- Testing: Are lab procedures and other tests appropriate to the diagnosis?
- Standard of Care: Does the provider's course of treatment exceed the accepted standards, based on the evidence in the patient's chart?
- Plan Language: Is a cosmetic treatment being "disguised" in order to receive fraudulent reimbursement coverage?
- Upcoding: Do the provider's charges reflect the exact course of treatment and corresponding payment codes, or have they been misrepresented to increase reimbursements?
- Pharmacy: are the prescribed medications appropriate to the symptoms and diagnosis?
- Systemic Fraud: Is there a pattern of misrepresentation across a number of cases, that can be easily detected through review of sample cases from a provider or patient group?
Do you have suspicions about a specific claimant or provider? If so, we can help. Avoid the costs of fraud and deception. Contact Us now for a free consultation.
"Healthcare fraud accounts for an estimated $100 billion in annual costs to American insurers, consumers and taxpayers every year. AllMed's mission is to reduce these costs, while making sure each patient gets the treatment they deserve, every time."
