Fraud, Waste, and Abuse Auditing and Recovery
Fraud, waste, and abuse are often hard to detect in healthcare – it differs from country to country throughout the European Union (EU). Using our proven techniques, our experience has yielded tens of millions of US dollars in recoveries for state governments.
PCG will review your billing history to identify patterns and outliers and use ‘Predictive modeling’ to determine which providers are likely to be targeted in the future. Our other activities within this scope include:
- Coordination of audit identification activities with on-going provider audits
- Development of consistent auditing protocols and communication to provider community
- Provider Outlier Identification
- Provider Profiling
- Analysis of claims payment accuracy, based on specific government directives and regulations
- Data mining for outlier or payment anomalies that could be overpayments, errors, abuse, or fraud
- Identification of billing or coding errors
- Program analysis
- Predictive Modeling
- Identification of underlying errors, abuse or fraud through utilizing claims trending experience
- Throughout analysis resulting from our programmatic and clinical expertise
We prepare formal protocols from our findings, provide chart reviews and on-site and desk reviews to ensure proper handling of payment documentation.. Our offer includes:
- Formal auditing protocols that are consistent across Acute and Long-Term Care services
- Desk audit reviews by experienced administrative and clinical auditors
- Consistent communication with providers throughout the process
- Creating a formal letter outlining preliminary findings, providing opportunity for providers to supply additional information
- Management reporting capabilities so leadership has up-to-date information about audit findings and recoveries
As a final step to Fraud, Waste, and Abuse identification we offer recovery of inappropriately paid funds and support in the appeals process. We guarantee consistent communication with providers throughout the entire process.
- Psychological and Pedagogical Assistance
PCG is a leading provider of consulting and technology solutions to support the organization of psychological and pedagogical assistance at schools. We gained our expertise through nearly 25 years of cooperation with schools and local governments in the U.S.
- Health Services
Public Consulting Group (PCG) helps providers, governments, public health agencies, and healthcare providers enhance quality of care, improve financial management performance, and redesign systems of care.
PCG Office
Address: Fabryczna 17, Suite 11,
90-344 Łódź
Telephone: +48 42 2908 221
FAX: + 48 42 2908 225
E-mail: info@pcgeu.com