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Effective Fraud Control Tactics for Insurers and Managed Care Plans
Effective Fraud Control Tactics for Insurers and Managed Care Plans Author:Daniel Anderson, Rick Matarante With health care fraud taking a big bite out of profits, it's critical for insurers and health plans to install internal fraud control units. Fighting fraud not only makes financial sense, it's increasingly being mandated by the states. Some states already require insurers to have special investigative units to combat fraud; others direct ... more »insurers to file fraud control plans with their insurance departments.Federal health insurance reforms enacted in 1996 gave insurers new tools to pursue providers and suppliers who commit fraud. These and other new provisions let insurers fight back the way government fraud enforcers have for years. Establishing a special investigative unit is a winning investment. Through the fraud it will unmask, the recoveries it will make, and the new fraud it will deter, your special investigative unit will pay for itself many times over -- if it is organized, staffed and managed effectively. This valuable new book provides a blueprint for starting your own special investigative unit, or improving upon the one you already have. You'll learn how it should be organized and staffed; how to get top management to buy in; ways to get the message out to employees; how to develop and pursue cases; how to network with law enforcement; the pros and cons of fraud reporting hotlines; the special concerns of HMOs; and much more.« less