Healthcare fraud analysis involves analyzing medical billing codes to uncover inaccuracies in services billed when compared with diagnoses. These codes include Current Procedural Terminology Codes (CPT), International Classification of Diseases, Clinical Modification codes, and Health Care Procedure Coding System codes (HCPCS).
Current clients include self-insured companies exploring the fairness and accuracy of billed medical expenses and health care organizations requesting third-party auditing.
R&G can identify:
- Improper use of service
- Medically unnecessary services
- Billing for services not provided
- Billing accuracy issues – over-billing for a higher rate
- Charging for supplies not utilized or over-utilized