Andy Tolsma

Andy Tolsma

Spotting the unseen menace: Medical provider fraud, waste, and abuse

Although the insurance industry is constantly plagued by suspicious claims activity, the unseen menace that’s leading to diminished profits is medical provider fraud, waste, and abuse. With a total...

Is Cost-Shifting to P&C Payers on the Horizon?

There are numerous provisions of the Affordable Care Act (ACA), aimed at reducing the cost of America’s healthcare. According to Healthcare Finance News , the cost-saving strategies include specifi...

Overview: Medical Fraud, Waste, and Abuse

Property/casualty insurers have long faced an uphill battle against medical fraud. Acquiring usable data has posed significant challenges, and the difficulty of sifting through the massive volume o...

5 Common Medical Fraud Schemes

Identifying relationships among disparate pieces of information is the key to pinpointing billing practices that indicate fraud, waste, and abuse. Finding those relationships, however, tends to be...

P&C Medical Fraud: 5 Insights for Investigators

Medical fraud perpetrated against property/casualty insurers costs the industry tens of billions of dollars each year. Until recently, special investigations units (SIUs) have struggled to address...

ISO MedSentry: Combating the rise in medical fraud

Medical fraud has become increasingly problematic for property/casualty insurers. This type of fraud, which has recently been a major focus for industry and governing organizations, is at the cente...

Medical Fraud: Reversing the Trend

Claims Journal recently reported that medical, auto, and workers' compensation fraud is on the rise and, as such, has become a major focus for industrywide and governing organizations in 2014. We...

ISO MedSentry detects suspicious medical billing

Property/casualty insurers have a new tool to accelerate the detection of suspicious medical billing activity — and take informed action. ISO MedSentry ™ uses a combination of advanced analytics,...