It’s raining RACs. And many other third party auditors. It seems like every submission of medical records is being scrutinized for omission and commission. Then enter artificial intelligence (AI). The use of AI in auditing, although relatively new, is here to stay. How is your facility faring compared to your peers? More audits? Less auditing? More denied claims? More money being recouped? Now you can see for yourself how you’re doing comparing to others. Thanks to the annual benchmark ...
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It’s raining RACs. And many other third party auditors. It seems like every submission of medical records is being scrutinized for omission and commission. Then enter artificial intelligence (AI). The use of AI in auditing, although relatively new, is here to stay. How is your facility faring compared to your peers? More audits? Less auditing? More denied claims? More money being recouped? Now you can see for yourself how you’re doing comparing to others. Thanks to the annual benchmark ...
Into a Rabbit Hole: Medical Loss Ratio Fraud Detected in Managed Care Program
Monitor Mondays
28 minutes
2 months ago
Into a Rabbit Hole: Medical Loss Ratio Fraud Detected in Managed Care Program
A recent case filed by the U.S. Department of Justice (DOJ) reveals how an insider was able to detect fraud in a large managed care organization (MCO). Although the topic of medical loss ratio (MLR) might be arcane to some, when the subject involves millions of dollars of potential fraud, it quickly becomes a large blip on the government’s fraud detection radar. More on this topic will be reported during the next live edition of Monitor Mondays. That’s when whistleblower attorney Max Voldman ...
Monitor Mondays
It’s raining RACs. And many other third party auditors. It seems like every submission of medical records is being scrutinized for omission and commission. Then enter artificial intelligence (AI). The use of AI in auditing, although relatively new, is here to stay. How is your facility faring compared to your peers? More audits? Less auditing? More denied claims? More money being recouped? Now you can see for yourself how you’re doing comparing to others. Thanks to the annual benchmark ...
