Emdeon Fraud Investigative Services

With Emdeon Fraud Investigative Services, government entities can combine retrospective claims analysis and prospective fraud detection techniques. Emdeon reviews and analyzes historical claims data, medical records, suspect provider databases and high-risk identification lists while also conducting beneficiary and provider interviews. We offer an outsourced Special Investigation Unit (SIU) that can help recover payment and supplemental investigation methods to augment existing SIU staff. Emdeon's services help ensure fair and accurate resolution to problems that develop at any point in the investigation.

With more than 20 years' experience in healthcare fraud detection, Emdeon's investigators have backgrounds in areas such as law enforcement, criminal justice, private investigation, claims investigation, statistics and analytics. Our onsite medical director, staff clinicians and certified coders further strengthen our investigatory process. We know knowledgeable SIU personnel are often critical to finding and stopping true fraud and our dedication to developing best practices has made us a market leader.

Because Emdeon works with more than 1,200 payer and government entities, we're able to provide clients with an innovative service that enables access to other discovered fraud and abuse schemes within the market. The depth of our data and analysis allows valuable communication among cost containment units interested in relaying information that could result in fewer false positives and more overpayment prevention. Consequently, those who opt for this service may detect schemes quicker and gain additional insight into trends and intentions of potential offenders.

Features

• Utilizes state-of-the-art fraud detection technology, FAMS, and a highly experienced team of investigators to identify fraud and abuse
• In-depth analysis and recommendations from market leaders
• Advanced technology that captures comprehensive data
• Outsourced SIU and recovery services available
• Payers can choose to share data with market peers

Benefits

• Prevents overpayments and duplicate payments
• Helps improve cost-saving opportunities and cost-recovery efforts
• Increases likelihood of catching potential fraud activity
• Adapts to existing programs and processes
• Helps discover more fraud and abuse schemes within the market