Processing Claims does not FWA Management make.
Dr Simon Peck At a recent meeting, one of our clients said that many people do not understand the difference...
USD 500k annual excess billing controlled at a leading dermatology clinic after 16 Mohs surgeries on one patient in 18 months
Case 3 · Provider Level · Asia-Pacific WHERE WE STARTED A blue-chip dermatology clinic in the Asia-Pacific region was billing...
Horses for Courses – Different Objectives of Clinical Coding
Dr Simon Peck In his book “Profiles of the Future: An Inquiry into the Limits of the Possible”, Arthur C....
Eight per cent of a £24m claims spend identified as potential FWA — and the biggest risk wasn't fraud. It was chronic over-treatment hiding in mental health.
Case 7 · Employer Level · United Kingdom WHERE WE STARTED A large UK employer — a household name —...
23,635 spinal patients analysed: impossible procedure combinations and unsafe device use identified — public inquiry upheld findings
Case 6 · Country Level · Australia WHERE WE STARTED Referred via a client partner, Kirontech was engaged to assist...
Organised Crime Group identified and referred to police: £500k–£1m in dental fraud stopped before further losses
Case 5 · Collusion Level · UK + International WHERE WE STARTED A large UK dental insurer was processing claims...
EUR 2.5m+ saved annually as unnecessary knee and hip procedures challenged across an entire insurer portfolio
Case 4 · Policy Level · Southern Europe WHERE WE STARTED A Southern European health insurer was processing high volumes...
Intraoperative injury identified and actioned: third-party recovery pursued following complex pelvic surgery
Case 2 · Patient Level · United Kingdom WHERE WE STARTED A UK private health insurer was processing claims for...
Fraud stopped before payment: USD 750k+ saved on fake cardiac ablation claims
Case 1 · Claim Level · Latin America WHERE WE STARTED One of Latin America’s largest national health insurers was...
The Power of Soft Power: Stopping Waste and Abuse
Dr Simon Peck In https://www.linkedin.com/pulse/misconduct-health-insurance-fraud-does-matter-kirontech-uk-ltd/ we discussed the differences between various kinds of FWA (Fraud Waste and Abuse) in Health...
The human element: managing FWA post-identification
In our previous bulletins, we discussed in some detail the identification of Fraud, Waste and Abuse (FWA) in health insurance...
Blood Money – FWA in Pathology
Dr Simon Peck In his classic book “License to Steal – how Fraud Bleeds America’s Health Care System” Malcolm Sparrow...