Indicators of Fraudulent Foreign Health Insurance Claims

HANDBOOK

 

Indicators Of Fraudulent Foreign Health

Insurance Claims: The Handbook  

 

 

                                        TABLE OF CONTENTS

 

Introduction

 

INDICATORS                                                                                             PAGE

 

Indicators based on claim documents………………………………….………1

 

·         The religious name of the clinic / hospital …………………………………2

·         The hospital’s name denotes government or

community ownership…………………………………………………...…...3

·         Hospital in a rural community ……………………………………………….5

·         Emergency Room (ER) or Casualty Ward ……………………………...…6

·         Intensive Care Unit (ICU) …………………………………………………..13

·         Coronary Care Unit (CCU) …………………………………………...…....19

·         High Dependency Unit (HDU) ………………………………………...…...20

·         Magnetic Resonance Imaging (MRI) …………………………………..….21

·         CT scan (Computerized Tomography scan) ………………………......... 25

·         Ultrasound scan ………………………………………………………......…29

·         ECG or EKG ……………………………………………………………........33

                                                               

                                                            ….

 

Indicators based on investigative reports …………………………………… 125

 

·         Physician’s notes in same consistent handwriting ……………………….125

·         Scanty clinical notes for lengthy admission …………...………………….126

·         Nurses notes in same consistent handwriting ……...…………………….127

·         Admission or patients’ register ……………………………………………..128

 

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PICTURES

 

·         Emergency Room (ER) ………………………………………………………11

·         Intensive Care Unit (ICU) in a hospital …………………………………......17

·         Magnetic Resonance Imaging (MRI) scanner / machine ……………...….23

·         Computerized Tomography Scan (CT scan) machine …………………….27

·         Ultrasound scan machine …………………………………………………….31

·         ECG/EKG (Electrocardiogram) machine …………………………………...35

·         ECG monitor ………...………………………………………………………...39

 

 

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MEDICAL EQUIPMENT CHECKLIST

 

·         Emergency Room (ER) / Casualty Ward ………………………………….142

·         Intensive Care Unit (ICU) ………………………………………………...…145

 

 

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·         ENT (Ear, Nose & Throat) Unit ………………………………………….…158

·         Eye Unit ………………………………………………………………………160

 

·         Dental Unit ………………………………………………………………...…161

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