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Upcoming CFID Provider Audits

In addition to the Corporate and Financial Investigations Department’s (CFID) role in combating fraudulent practices against AmeriHealth, CFID is also responsible for conducting audits of facility and professional providers, ancillary service providers, and pharmaceutical-related entities. By using sophisticated data-mining software tools, CFID analyzes claims and compares them to member enrollment data and overall provider information. Any trends, patterns, or aberrant billing practices are selected for an in-depth audit or investigation.

Upcoming audits to investigate trends in questionable billing

Based on recent trends that have been identified in the data, CFID would like to alert providers to some questionable billing practices that will be the focus of upcoming audits. Note: If you are selected for an audit, you will be notified by certified mail.

For a full list of the planned upcoming audits, please refer to the November issue of Partners in Health Update^SM.