How Can Decision Intelligence Help Identify Medical Provider Facilitation & Collusion?

Alex_Johnson Posts: 43 QUANTEXA TEAM
edited January 16 in Specialist User Groups

⚠ Year after year, we’ve sadly seen a rise in medical provider & billing scams costing the industry millions of $$$ each time! Fraud related to medical practitioners using malpractice, shell companies and straw ownerships of clinics is on the rise.

We've recently seen many repeated trends, including a specific case totalling over $1m below 👇

⚙ With the right #contextualdecisionintelligence technology, you can easily spot hidden patterns, connections and collusive networks. Connecting public records, corporate records, exclusions with internal payments, billing and claims data creates a #provider360 / #supplier360 approach to deliver intelligence to stop this before a big court case / significant losses.

👉 Previously disbarred medical practitioners setting up under new licenses and businesses
👉 Practitioners re-appearing a few years after convictions for bribery, corruption, forgery and tax fraud
👉 Shared location and contact details including family associations with risky clinics &/or practitioners
👉 Shell company registrations, multiple company filings and repeated dissolved companies
👉 Company directors with links to new practitioners not yet under investigation
👉 Business links to residential and temporary office addresses, for example medical manufacturers, pharmacies, physicians and more

I would love to hear your thoughts on this? @Shyam_Bhatt @Ross_Aubrey @Holly_Miller @Molly_McElrath @Ivan_Heard @Steve_Lenderman ++