Payers
Ingenix Platforms
See our strategic compilations of data, software, analytics, and consulting that address Payment Integrity in bright new ways.

(And their demonstrated ROI.)
View More
Insurance industry sees shift to money management

Aetna steps up efforts to promote online medical records

AHIP finds payers leading the health IT movement

Aging boomer population leads payers to introduce new products

Insomnia patients can get online help through their insurers

Fraud and Abuse Detection

We are established experts in detecting, preventing, and recovering overpayments due to fraud and abuse, incorrect coding, third party responsibility or liability, and simple errors. We have developed one of the most comprehensive set of solutions available.

Prospective Detection Services prevent overpayment on potentially fraudulent or aberrant claims.


Detection Services

Prospective Detection and Investigations identify fraudulent and abusive claims for investigations before the claim is paid. With this service, we can help you achieve savings seven to ten times greater than recovery efforts alone.

Fraud and Abuse Detection services help you:

  • Prevent payment on erroneous claims
  • Discover potentially fraudulent claims
  • Recover overpayment losses

Injury Coverage Coordination

Gives you the unique ability to either fully or partially avoid claim expense by coordinating coverage with workers' compensation, automobile medical policies, no-fault, or other non-group medical reimbursement systems on accident-related injuries prior to paying the claim.

Retrospective Fraud and Abuse Service

This service includes expert evidence analysis, interviewing, medical records review, and case documentation. For the cases that progress into the recovery stage, an experienced team of professionals then perform a deeper level of investigation, coordinate recovery negotiations, agree upon and arrange settlement agreements, and recover dollars.

Privacy Policy  |   Terms and Conditions