The fraud does not involve the costs to the customer, nor the coverage supplied.
The fraud is in the reporting to the government for their rebates/payments from the government.
You may not see this on any parts of the payer side, nor the hospital side, nor the coverage side.
So nots not about defrauding the insurance customer as much as it's about defrauding the payer, the US government. That part is all in the coding of the submission to the government, which is not what you see nor read in any of your statements.
Coachk constantly reviews government/regulatory/ submissions for error corrections, which occurs due to human data entry, example is a 60 lb baby delivered. the decimal was in the wrong place or there was a key stroke error, true story. Most data entry points don't have logic validation steps attached, which would even more slow down the tedious data entry process.
good luck to us!
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