Billing fraud creates an enormous loss of resources to both private and government insuring bodies. Investigating allegations of insurance fraud is a labor intensive exercise. At Essential Edge we have the experience of auditing billing records to investigate private providers or institutions for determination of appropriate billing practices; and compliance of state and federal rules and regulations. A thorough understanding of appropriate use of ICD and CPT coding is just one component of the essential skills our team possesses for this area of investigation. We have assisted with large scale audits for alleged Medicare and Medicaid fraud and have gathered critical data used in the successful prosecution of fraudulent practice groups.
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