Our client was a state regulator of a workers compensation scheme who was concerned about the incidence of fraud and abuse it believed was occurring in certain areas.
The project involved analysing 32,000 lines of medical billing claims including anaesthesia, surgery, surgical assisting, diagnostic imaging, procedures for pain including spinal cord stimulators, miscellaneous diagnostic and therapeutic investigations and procedures, and pathology.
We conservatively estimated that 33% of claims were incorrect, totalling almost $10 million.