Healthcare Fraud Detection and Prevention

The National Health Care Anti-Fraud Association estimates that there is approximately $68 billion in healthcare insurance fraud annually. McClellan Bernstiel routinely works with managed care organizations and pharmaceutical companies to identify and prevent healthcare fraud both at the pre-payment and post-payment levels. Partnering with internal SIU teams as well as valuable outside consultants, McClellan Bernstiel leads efforts to analyze complex claims data to investigate and identify potential fraud, waste, and abuse. Within the claims system, McClellan Bernstiel is well-versed in detecting fraud identifiers such as improper billing and coding patterns, ineligible members and providers, and contract violations. Once detected, McClellan Bernstiel collaborates with in-house counsel and the relevant enforcement agencies to develop cost-effective and efficient plans by which to prevent the fraud, waste, and abuse from occurring as well as to bring appropriate legal action to recover fraudulently obtained funds.