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Auditing Department- Fraud & Abuse

FMC Network UAE has two main mechanisms for applying providers audit process, Offsite and onsite audit.

Offsite analysis is based on integrated system rules engine following international standard of coding guidelines and regulatory standards, Evidence based medical management and Benchmarking and trending analysis of provider’s utilization.

On site audit is based on selection of most suspicious files based on Data analysis, Incidental visits and Provider log feedback