Health Care Fraud & Abuse for MCO’s, IPA’s and Medical Providers

T&M’s Health Care Fraud & Abuse (HCFA) unit provides managed care organizations (MCO’s), independent practice associations (IPA’s) and medical providers with health care fraud, waste and abuse management services. Experienced investigators, auditors and forensic accountants detect fraud through data mining and meticulous review of records benefitting medical organizations that are seeking to reduce medical loss ratios, recover provider overpayments, recognize cost savings and achieve optimal operational efficiency while maintaining compliance with state and federal legislation.

Services include:

  • Providing comprehensive outsourced Special Investigation Unit (SIU) services.
  • Developing and implementing corporate Fraud, Waste & Abuse (FWA) Compliance Programs.
  • Assisting with audits and reviews of claims submissions, coding and current billing practices and procedures to uncover fraud, waste and abuse.
  • Conducting tailored fraud awareness training for contractors, vendors, providers and employees.
  • Preparing customized Fraud & Abuse Prevention Plans (FAPP’s) for submission to regulatory authorities.
  • Performing data analysis to identify aberrant providers.
  • Implementing and monitoring corrective action plans and proactively recovering overpayments from providers and vendors.
  • 24/7 Fraud & Abuse Hotline Services, staffed by trained operators.

T&M’s HCFA team is comprised of Accredited Healthcare Fraud Investigators (AHFI’s) certified by the National Health Care Anti-Fraud Association, Certified Fraud Examiners (CFE’s) certified by the Association of Certified Fraud Examiners, Certified Public Accountants (CPA’s), Certified Professional Coders (CPC), clinical reviewers and former prosecutors and law enforcement executives who are recognized industry experts in their fields with extensive healthcare management and field operations experience.

See also Health Care Fraud & Abuse for Law Firms.