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Detailed Bill Review May Help Block Fraud

By Elaine Goodman (medical/business Reporter)

Thursday, June 9, 2016 | 2088 | 2 | 48 min read

As California officials are calling for a review of workers’ comp fraud-fighting practices in the state, some cost-containment providers are saying that bill review can be an effective tool for detecting fraud. Bill review can play “an integral role” in workers’ comp fraud detection, yet it is an often-underrated approach, Tom Sebold, senior vice president of medical review services for Genex Services, said in an “Inside Workers’ Comp” article posted this week. Clinical edits or flags that point to instances of possible overutilization in pr...

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