Managed care requires new ways to find fraud
Article Abstract:
The advent of a health insurance market dominated by managed care will require different fraud-prevention techniques. The typical fraud investigation that is based on fee-for-service medical care is inadequate. Managed care contracts should be constructed to address the most common types of fraud, such as billing for services not rendered, upcoding and kickbacks for referrals. Some of the fraud in these schemes is difficult to document, and investigators will need better medical knowledge.
Publication Name: Best's Review Life-Health Insurance Edition
Subject: Insurance
ISSN: 0275-0988
Year: 1995
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Holding the line on behavioral health costs
Article Abstract:
Employers are contracting behavioral health carve-out companies to manage mental health and chemical dependency costs. Carve-out firms have developed several strategies to control costs, including developing preferred provider panels, requiring concurrent utilization reviews to provide evidence of medial necessity and requiring precertification for intensive services.
Publication Name: Best's Review Life-Health Insurance Edition
Subject: Insurance
ISSN: 0275-0988
Year: 1996
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Managed results programs coordinate benefits delivery
Article Abstract:
Employee benefits programs could be less costly if they were operated as a managed results program. Disability, return-to-work programs and medical care would be connected rather than managed by several different departments within a company. Many companies have each facet of their benefits programs managed by different insurance firms.
Publication Name: Best's Review Life-Health Insurance Edition
Subject: Insurance
ISSN: 0275-0988
Year: 1996
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- Abstracts: Risk management market opens up in Japan. Expanding overseas carries special risk considerations. An electronic forum for the business of risk
- Abstracts: Embracing technology adds to agency power. Technology to go: four insurers have found new ways to turn their technology savvy into profit centers by selling their expertise to other industries - even to direct competitors