| 摘要 |
A system and method of determining and preventing medical billing fraud in the posting of medical insurance claims in which a clearing house is established for receiving information transmitted from a plurality of providers administering treatment covered by various insurance plans. For example, a computer system located in the clearing house would monitor the information provided by each of the providers to determine whether the providers submitted multiple claims for a particular period of time. The computer system located in the clearing house would also determine whether other inappropriate claims were made by the providers. If the computer system located in the clearing house determines that the treatments were proper, the providers would be paid by the computer system located in the clearing house in a timely manner. If the computer system located in the clearing house determines that the potential for medical billing fraud exists, payments to the health care provider may be delayed. |
