Investigations
While the typical healthcare fraud investigation process varies based on the allegation under review and the evidence needed, Integrity Advantage can provide the support and staff to augment your SIU or FWA team.
Our investigative services include:
- An in-depth and focused analysis on the allegation / subject
- Background research and sanction checks
- Probe or statistically valid random samples
- Surveys
- On-site or desk audits
- Interviews of members and providers
- Calculation of identified losses, recoveries, savings and prevented losses, as appropriate
- Provider communication/education
- Support for negotiation and settlement of overpayments
- Prepayment monitoring
Integrity Advantage can also provide a fully outsourced SIU model for those organizations who would benefit from utilizing a services partner to handle the detection, investigation and clinical review. Our staff completes all of the necessary steps to ensure a thorough investigation, as well as provide litigation support, if needed.