🩺 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 Health Solutions' 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.
Our Special Investigation Unit (SIU) delivers end-to-end fraud detection, investigation, and compliance support for healthcare payers.
Our SIU teams review and analyze healthcare claims to identify irregularities, potential fraud, and overpayments by examining claim data and supporting documentation.
Advanced analytics are applied to claims data to uncover hidden patterns, anomalies, and trends that may indicate fraud or abuse.
We conduct in-depth investigations into suspicious claims, including evidence collection, stakeholder interviews, and coordination with law enforcement when necessary.
Support in designing and implementing fraud prevention policies and standardized procedures to strengthen claims governance.
Audits of healthcare providers are performed to ensure billing accuracy, contractual compliance, and adherence to regulatory standards.
Comprehensive documentation and reporting of investigations, findings, and corrective actions to meet audit and compliance requirements.