DecisionHealth, DecisionHealth - 2012 Issue 1 (January)

How to handle investigations by a private payer’s ‘special investigations unit’

While it’s no fun undergoing a routine billing audit from a private payer, it’s usually just part of doing business. But your relationship with a payer can really take a nosedive if you end up investigated by a payer’s “special investigations unit” (SIU). Unlike a general payer audit, SIUs specialize in combating fraud, waste and abuse, typically launching an investigation once a larger billing problem has been identified by the payer.

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