CASE STUDY

Fraud detection on invoices

CASE
Medigo was asked by an insurer from the Gulf to review a large number of invoices. These were submitted for reimbursement and pertained to treatment obtained in France where the member resides. These included invoices for consultations, scans, a paediatric inpatient stay as well very high value pharmacy prescriptions and surgical procedures.

SERVICE

Medigo conducted an assessment of the medical necessity of all procedures performed, reviewed over 20 invoices, and contacted all facilities to understand the protocols involved and to check whether the invoices were valid.

OUTCOME
Although the case did exist, the invoices were deemed as likely fraudulent, saving the client nearly EUR 98,030 in claims from a single member.