title: Medical consultant key to dealing effectively with insurance fraud and abuse.
abstract: An unexpected, but everpresent, by-product of the development of the health care insurance industry is the tendency of those using the industry's services to "game" the system. While fraud and abuse in the claiming of insurance benefits are not the only or the most significant cause of steeply rising health care costs, they certainly contribute to the problem. Payers are advised to maintain a sharp eye for potential fraud and abuse and to observe some simple rules for detecting and eliminating them.
mesh_terms: D003253:Consultants; D003415:Crime; D005607:Fraud; D006264:Health Benefit Plans, Employee / Q000592:standards*; D007345:Insurance Claim Review / Q000379:methods*; D007348:Insurance, Health / Q000379:methods* / Q000592:standards*; D014481:United States