Members > Physical Therapy > Fraud and Abuse
Fraud and Abuse
The increasing cost of healthcare is an important concern for all of us. There are many contributing factors that lead to the increase in healthcare costs. One of the most prevalent factors is fraud and abuse by healthcare providers and members. At Prism we take a variety of measures to prevent fraud and abuse by healthcare providers and members.
Provider and Member audits are performed to ensure that claim submissions are consistent with actual medical record documentation, and that applicable guidelines are adhered to in the submission, delivery, billing, and reimbursement of services rendered.
This is accomplished through a variety of measures:
- Utilizing current, state-of-the-art data-mining software applications.
- Fraud Hotline to report allegation of fraud and/or abuse.
- Interviews, Confirmations & Questionnaires are all utilized to identify or confirm fraudulent or abusive activity.
- Comprehensive post-payment review and analysis of claims paid to participating providers.
- Medical record review by qualified, experienced professional staff.
- Employees are provided training in fraud prevention and detection methods.
If you suspect Fraud or Abuse please call our hotline 1-877-254-3975 to report your suspicions. A trained professional will work with you to follow up on your concerns.
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