Fraud and Abuse

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Fraud and abuse divert significant resources away from necessary care that is covered by a health plan. Salutics' fraud and abuse detection platform uses your data in conjunction with other relevant, non-medical data to identify abnormalities. Salutics' fraud and abuse platform is a rule-based detection system that allows you to tune it to your plan's needs.

The most common types of fraud and abuse occur in the following areas:

  • Medical identity theft
  • Billing for unnecessary services and items
  • Billing for services or items not rendered
  • Upcoding
  • Unbundling
  • Billing for non-covered services or items
  • Kickbacks
  • Beneficiary fraud

Salutics' onGuard watch can provide alerts and necessary tracking automatically.