Safeguard your dedication to healthcare excellence. Our Special Investigation Unit services ensure you operate within a protected sphere, meticulously defending against fraud, waste, and abuse that threaten the integrity of your healthcare services.
Healthcare payers often deal with significant challenges, such as attempting to bill for services that were never actually provided, charging for medications that were never administered, providing false information about treatments, and even seeking unlawful payments for patient referrals.
Aventis RCM’s efforts focus on reducing fraudulent activities by following potential leads, conducting research, educating associates and customers, and collaborating with law enforcement, government agencies, and even competitors to actively detect and prevent fraud, waste, and abuse, which is why we’re proud to introduce our comprehensive Special Investigation Unit (SIU) services.

Who we serve

Our Services

Our SIU teams review and analyze healthcare claims to identify irregularities, potential fraud, or overpayments. This involves scrutinizing claims data and documents for inconsistencies.

Claim Investigations

We conduct investigations to delve deeper into suspicious claims. This may involve collecting evidence, interviewing parties involved, and working closely with law enforcement if necessary.

Provider Audits

Our SIU may conduct audits of healthcare providers to ensure they are billing accurately and in compliance with contractual agreements.

Data Analysis

We use advanced data analytics to identify patterns and anomalies in claims data that could be indicative of fraud or overpayment.

Policy Development

Help in developing and implementing policies and procedures to prevent fraud and streamline the claims process

Reporting and Documentation

Detailed reporting and documentation of investigations, findings, and actions taken for compliance and audit purposes.

Scope of Our Services

Detailed reporting and documentation of investigations, findings, and actions taken for compliance and audit purposes

Investigation and reporting suspected or proven fraud, waste, and abuse.

Partnership with law enforcement, governmental agencies, and other insurance carriers to share appropriate information.

Establishing and implementing systematic & effective methods of preventing potential fraud, waste, and abuse.

Conducting anti-fraud awareness training with non-SIU associates.

Why Choose Us

Our Special Investigation Unit services ensure you operate within a protected sphere, meticulously defending against fraud, waste, and abuse that threaten the integrity of your healthcare services.

Dedicated Investigation & Oversight

From identifying suspicious patterns to thorough investigative pursuits, our SIU doesn't just uncover fraudulent activity.

Prevention Through Education

Our approach involves empowering associates, clients, and the community through robust anti-fraud awareness programs.

Collaborative Defense Strategy

This united front amplifies our resilience, fortifying our defenses, and ensuring that deceptive practices have no place to hide.

Comprehensive, Systematic Safeguards

Our commitment is backed by the implementation of innovative and effective methods tailored to prevent potential risks.