Medical Fraud Analysis
Identifying trends and patterns occurring in a provider’s medical treatment and/or testing is one of the many aspects SIU is faced with when deciding on allegations of fraud.
Signet created the fraud analysis report based on the need to have a HealthCare Professional review suspicious bills and/or treatment, identified by carrier, third party administrator, law firms and determine if a pattern exists that is contrary to the standard care.
Signet has partnered with SIU units by providing experts with similar credentials as the treating provider and have a comprehensive knowledge of the treatment and/or testing being performed and has experience in billing/coding issues. Our experts can support SIU efforts by providing reviews that highlight the treatment and testing being repeatedly performed, by explaining what these procedures are, how they should be done, what are the protocols for these procedures and identifying patterns in the procedures performed on numerous claimants by a given physician.
In cases where a defense attorney is already involved, the expert will help in constructing the EUO questions and appropriate responses.