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Uniting Against Healthcare Insurance Frauds
Insights from the First Roundtable by Mains Lab
The primary focus of our inaugural workshop centered around the prevalent issue of fraud, waste, and abuse (FWA) perpetrated by medical providers within the realm of health insurance.
Held in an inviting and cordial atmosphere, our colleagues shared their invaluable experiences in detecting FWA, utilizing methods such as mystery shopping and medical record investigation. Furthermore, they engaged in insightful discussions regarding specific cases, including phantom claims, phantom diagnosis, and claims splitting. Legal dimensions concerning the mitigation of abuses and evidentiary practices served as pivotal points of discourse.
Held in an inviting and cordial atmosphere, our colleagues shared their invaluable experiences in detecting FWA, utilizing methods such as mystery shopping and medical record investigation. Furthermore, they engaged in insightful discussions regarding specific cases, including phantom claims, phantom diagnosis, and claims splitting. Legal dimensions concerning the mitigation of abuses and evidentiary practices served as pivotal points of discourse.
Dear friends,
We are happy to announce a significant milestone that transpired last Friday! Mains Lab successfully hosted the inaugural Health Insurance Workshop, wherein leaders in health insurance claims from prominent insurance companies in the CEE region convened.
We are happy to announce a significant milestone that transpired last Friday! Mains Lab successfully hosted the inaugural Health Insurance Workshop, wherein leaders in health insurance claims from prominent insurance companies in the CEE region convened.
publication date:
February 1, 2024
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We took great pride in inviting Dr. Faisal, a distinguished authority in the field, as our special guest expert. Dr. Faisal, who serves as the Medical Director responsible for medical operations and claims management at Total Care Saudi, the largest Third-Party Administrator (TPA) in Saudi Arabia, shared an illuminating presentation on prevalent types of fraud in Saudi Arabia, their unique characteristics in detection, and dispensed invaluable practical advice and recommendations to all participants.
Dr. Faisal
Total Care Saudi
On behalf of Mains Lab, we want to express our gratitude once again to all industry experts who accepted our invitation and participated in this Health Insurance Workshop!