Containing the Rising Costs of Health Care

The National Health Care Anti-Fraud Association and the Federal Trade Commission estimate that one half of all health insurance claims are either fraudulent or over-billed. The health care industry represents a total expenditure of over $800 billion each year. With little or no way of validating these claims, the exposure to medical insurance fraud and/or over-billing has run rampant. ICS can help your company identify these inappropriate charges and enable you to contain the rising costs of insurance claims and settlements.

Established in Stevensville, Maryland in 1985, ICS has grown into a nationwide firm specializing in the review and analysis of medical insurance claims to identify unreasonable, inappropriate, or redundant charges. This is accomplished through a network of more than 500 Board-Certified physicians in all specialty fields and Registered Nurses, who act as independent contractors to ICS. F. Brian Richter, President of ICS, points out, "These consultants are medical professionals with many years of experience in their field(s) of expertise. All physicians are active practitioners with thriving practices of their own."

The ICS concept is simple but effective. When an insurance company, government agency, or attorney believes that a particular medical claim may be excessive or inappropriate in any way, they refer the file to ICS for review and analysis. A specialist in that field reviews the case according to guidelines established by the American Medical Association (AMA) and the New England Journal of Medicine, and then renders an objective opinion as to which charges are reasonable and justified, as well as those that are inappropriate, unreasonable, or redundant.

According to Mr. Richter, the most common inconsistencies revealed are improper documentation, mis-diagnoses, and the presence of pre-existing conditions, excessive or redundant testing, and over-billing. When an insurance company/claimant or physician recognizes that another professional is reviewing the documentation and billing, the charges are often adjusted without further dispute. All of ICS’ physician and nurse consultants have agreed to testify in court in support of their findings, if required.

The explosive growth in the number of plaintiff attorneys is evidenced by the television ads claiming, "If you have a telephone, you have an attorney." As a result, physicians may have a tendency to call for more testing or redundant treatment, for fear of not treating enough. An objective analysis of billing records and treatment notes by ICS professionals will assist the insurance company in controlling these excessive and unreasonable costs. Studies show that those companies aggressively addressing the reduction in health care costs are reporting impressive results with returns as high as $15 for every dollar spent. Of the many referrals that ICS processes each month, Mr. Richter estimates that ICS saves the client from 18 to 38 percent on the total claim. Obviously, the ICS concept is cost effective for our clients. "This problem affects all segments of society and I would like to be able to say that we’re fixing the problem. Excessive losses are passed on to policy holders and a single accident claim can often result in cancellation of a policy," Mr. Richter states. "Although we cannot eliminate all over-billing and inappropriate charges, we can create the awareness that the abuse is there and encourage the industry to refer questionable claims for review and analysis, rather than just pay them."