Case Managers need to be aware of the warning signs called “red flags” that indicate a claim may be fraudulent. Such signs may indicate the need for closer scrutiny and further investigation during the claims handling process. The existence of more than one fraud indicator does not necessarily mean that a claim is fraudulent. Indicators of fraud may exist purely through coincidence in legitimate claims. Claims that raise concerns need to be examined carefully before final conclusions are drawn.
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There are several types of DME fraud; however, the DME fraud we are focused on in this blog is unnecessary equipment fraud.
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