Updated: April 16, 2020
These are uncertain times. We understand that you may have concerns about suspect claims made under your benefits plan. We’re here to reassure you. We continuously evolve our investigative strategies to address any new channels for suspect activity. This includes the potential for fraud and abuse related to virtual services offered by paramedical providers.
We have advanced data analytics, external partnerships and an experienced fraud risk management team. Together, these provide the capabilities we need to address new risks and changing trends.
Changing times, changing strategies
To follow physical distancing orders, plan members are now using more virtual services. We’ve also extended coverage for virtual services for some paramedical providers.
When we introduce a new product or service, we develop additional ways to reduce fraud and abuse risks. To address the anticipated rise of plan members using virtual services, we’ve taken the following actions:
- Communications with regulators. We’ve discussed virtual services with dental and paramedical regulators and associations to confirm the scope of virtual services offered.
- Increased monitoring. We’ve enhanced our monitoring of medical and dental claims across all plan member and provider submission channels. This monitoring accounts for the new and additional risks introduced in this environment. This includes introducing new fraud detection methods to adapt to the changing environment.
- Focus on providers and facilities. Our analytic capabilities can identify billing irregularities by provider and facility. This lets us take appropriate action against providers who may take advantage of benefits plans.
In addition to these actions, we continue our regular screening of claims and monitoring of all tips and referrals. We’ll continue asking plan members for additional information when needed to process claims.
Protecting your plan from fraud and abuse remains a priority for us.