Using data analyses to monitor for fraud and abuse
Health Care Auditing Strategies, December 1, 2006
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Using data analyses to monitor for fraud and abuse
Although there are several procedures that you can use to monitor for the identification and verification of potential fraud and abuse, data analysis is the first step that you should take to eliminate potential areas of vulnerability.
Data analysis is the comparison of claim information and other related data with claim characteristics (e.g., diagnoses, procurers, or beneficiaries individually or in the aggregate) to identify potential error/fraud. Data analysis is an integrated, ongoing activity.
The ability to make use of available data and apply innovative analytical methodologies is critical.
This is an excerpt from a member only article. To read the article in its entirety, please login.
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