AUDITING - FRAUD, WASTE & ABUSE

FMC Network UAE has two main mechanisms for applying providers audit process, Offsite and onsite audit.Our in-house medical audit team consists of medically qualified coders conducting offsite and onsite audit services to validate suspicious claims and ensure recovery of any overpaid claims. Our claims validation or audit services review claims for potential up-coding, billing for non-existent prescriptions, medical necessity, inflation of charges, duplicate billing and billing of non-rendered services. Our coding team also cover all other issues related to Fraud, Waste and Abuse.

Offsite analysis is based on a built in system rules engine that adheres to international standards. Evidence based healthcare management and benchmarking are combined with provider usage trend analysis to give a detailed body of data. The On-site audit is based on selection of the most suspicious files based on Data analysis, Incidental visits and Provider log feedback.