Healthcare

Mitigate Medical & Prescription Fraud

Healthcare

Our Healthcare Solution can reduce fraud risk from the first 5 types of fraud.

Healthcare Fraud is estimated to comprise as much as 3% of total spending. It takes multiple forms including:

  1. Medical Identity Theft: Aside from illicit billing this may add widely inaccurate medical information to a patient’s record, leading to inappropriate medications and procedures and may even make the person uninsurable and cause significant emotional harm

  2. Using Fake IDs: Obtaining healthcare coverage under false pretences, whether due to lack of coverage or non-resident status

  3. Fake Billing: Billing for services never rendered

  4. Prescription Fraud: Charging for prescriptions not procured or procured for a different person

  5. Care Home Fraud: Billing for nursing care home for non-existent residents

  6. Up-Coding: Billing for more expensive treatment than delivered and over-charging Governments and Insurers

  7. Performing medically unnecessary procedures: Falsifying a diagnosis to justify tests and increase billing

  8. Misrepresenting Treatments: Stating medically unnecessary treatments are required to obtain insurance coverage fraudulently, e.g. cosmetic procedures

Automate Smart Workflows

  • Accurately identify your patients and clients
  • Ensure the genuine person receives treatment, insurance coverage and prescriptions
  • Eliminate manual reviews
  • Increase conversions
  • Strengthen compliance
  • Simplify onboarding and sign up new clients efficiently and cost-effectively

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