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 has implemented a variety of preventive measures to reduce fraudulent activities by credentialing high-quality practitioners and performing audits. 

Medical record audits are performed to ensure claim submissions are consistent with medical record documentation and that 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 & Questionnaires to identify or confirm fraudulent or abusive activity.
• Comprehensive post-payment review and analysis of claims paid to participating providers.
• Specialized employee training in fraud prevention and detection methods.

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