Page 367 - Ebook health insurance IC27

Sashi Publications

 Use of our special investigative unit to look into suspicious claims and report
fraud to local and state authorities.

 Fraudulent claims when discovered and proved should be liable to strict legal
action and insurers need to join hands with the regulatory authorities to penalize
the fraudsters.

 Fully investigating fraudulent claims to stop further loss prosecute perpetrators,
recover any loss upon discovery.

 Fraud awareness training for their claims and investigative staff to identify
potential fraudulent cases.

 Robust fraud detection tools to deal with the full spectrum of health benefit
products and wide array of participants in the healthcare market - doctors,
hospitals, pharmacies, pharmacists, dentists, equipment suppliers and more.

 Developing the concept of "Partner Providers" rather then "network hospitals"
and sharing the insurance risk with them.

 Taking patient signature on the bills, preauthorization request note.
 Use of document management system (DMS) which will help in easy retrieval

of patient previous claim and clinical history if any at the time of settlement of
subsequent claim.
 Sharing the list of fraudulent providers with all insurance companies, medical
councils, doctors association and the insured.
 Promotion of "fraud hotline".
 Rewards if any someone reports about fraudulent claims.
 Discouraging treatment in non-network hospitals by introducing co-payment.

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