One of the most prevalent factors associated with the escalating rise in healthcare cost is fraud and abuse by providers and members alike.  At Palladian, our Quality Management and Improvement Department implemented a variety of preventive measures to reduce fraudulent activities by credentialing high-quality practitioners, and performing provider audits. 

Medical record audits are performed to ensure claims submissions are consistent with medical record documentation, and applicable regulatory guidelines are met. Additional measures include: 

• Utilizing current, state-of-the-art data-mining software applications.
• Fraud Hotline to report allegation of fraud and/or abuse.
• Interviews, confirmations and questionnaires to identify or confirm fraudulent or abusive activity.
• Comprehensive post-payment review and analysis of claims paid to participating providers.
• Specialized employee training fraud prevention and detection methods.

If fraud is detected legal counsel performs a thorough investigation and may work collaboratively with outside agencies, which include, but are not limited to, verification agencies and/or the District Attorney’s Office.

If the alleged fraud or misconduct is substantiated, client health plans are notified, the provider is reported to the National Practitioner’s Databank, and terminated from Palladian’s network of participating providers.

If fraud and abuse is suspected please contact Palladian’s confidential phone line at 1-877-254-3975; calls may be left anonymously.