Reimbursement claims are often submitted after treatment is complete, making them highly susceptible to retrospective documentation fraud. **Grace Power Verification India Pvt Ltd** specializes in the forensic audit of these claims. We verify that the medical expenses claimed are authentic, the treatment was actually provided, and that the billing adheres to standard healthcare pricing.
Unlike cashless claims, reimbursement claims allow more time for fraudulent actors to create "Paper Cases"—where a patient was never admitted, but a complete set of medical records and bills is fabricated. Common issues include the submission of fake pharmacy bills or laboratory reports for tests that were never conducted.
Our presence in the Salem regions ensures we can physically reach out to hospitals and clinics to verify the entries in their OPD and IPD registers, ensuring the claim is not based on ghost-admissions or inflated medical invoices.
We follow a detailed investigative path to ensure that every document submitted for reimbursement is legitimate:
We cross-verify the discharge summary and final bill with the hospital's internal records to ensure the patient ID and admission dates are consistent.
Our team visits the diagnostic centers and pharmacies mentioned in the claim to verify the serial numbers of bills and the actual purchase of medicines.
We conduct a post-discharge physical visit to the claimant’s home to assess their health status and verify if it matches the clinical notes provided in the claim.
