Fraud and abuse divert significant resources away from necessary care that is covered by a health plan. Salutics' fraud and abuse detection platform uses your data in conjunction with other relevant, non-medical data to identify abnormalities. Salutics' fraud and abuse platform is a rule-based detection system that allows you to tune it to your plan's needs.
The most common types of fraud and abuse occur in the following areas:
- Medical identity theft
- Billing for unnecessary services and items
- Billing for services or items not rendered
- Upcoding
- Unbundling
- Billing for non-covered services or items
- Kickbacks
- Beneficiary fraud
Salutics' onGuard watch can provide alerts and necessary tracking automatically.