Specialty Care Provider Orientation - MetroPlus Health Plan
Specialty Care Provider Orientation - MetroPlus Health Plan
Specialty Care Provider Orientation - MetroPlus Health Plan
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<strong>MetroPlus</strong> Fraud and Abuse PreventionProgram con’t• <strong>MetroPlus</strong> Special Investigations Unit (SIU) <strong>MetroPlus</strong> has a dedicated SIU that is responsible for performingprovider-based fraud and abuse audits and investigations The SIU accepts tips, referrals and allegations of fraud or abusefrom a variety of internal and external sources Some examples of the fraudulent and abusive activities that theSIU audits and investigates for are: double billing, upcoding,overutilization, lack of medical necessity, unbundling, billing forservices not rendered, billing for services without a license, etc.20
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