Forensic Auditing

Working in conjunction with the investigative team, URS can provide targeted Medical Bill Auditing to help identify and document excessive or fraudulent provider billing. Our qualified Auditing R.N.s utilize their clinical experience and widely accepted resources in analyzing specific billing trends with certain providers. We can also conduct audits at the provider’s location, where we can evaluate the clinical setting to determine whether the billed treatment was actually rendered and whether the office or clinic is qualified and has the actual staff and equipment to render the treatment.

Targeted Areas for Auditing:

• Excessive billing or treatment
• Medical coding maximization
• Inappropriate diagnostic codes
• Causality Issues
• Billing above R&C
• Multiple modalities and testing on every visit
• Lack of medical documentation
• Repetitive "boilerplate" medical reports
• Billing out of specialty

Our audits are completed with a detailed report, listing all findings and recommending appropriate levels of payment for services actually rendered and related to the claim. Our R.N. Auditing Specialists are available for testimony if needed. Our reports can be used to support negotiations, arbitrations or other proceedings.

Our forensic auditing services are most helpful to attorneys, SIU investigators and claims professionals looking to resolve provider billing disputes or identify and quantify suspected areas of fraud or abuse.