Counsel to a behavioral health provider network reached out to CRA’s Forensic Services Practice after potential areas of noncompliance surfaced during a routine internal review. Our team conducted forensic analysis that revealed inconsistently-applied billing modifiers across providers, settings, and services. While the claims had often passed internal checks, they generated a combination of underpayments and overpayments, causing regulatory exposure and creating reputational risk. The team quantified the exposure and recommended coding protocol refinements and targeted staff training to prevent future issues.
CRA strengthens its Forensic Services Practice
“We are excited to welcome David to the CRA team,” said Paul Maleh, President and Chief Executive Officer of Charles River Associates. “With over 20 years of...