Overpayment Identification & Recovery

HRI is highly experienced in the use of statistical and predictive models designed to identify overpayments and patterns of inappropriate billing for medical services and supplies such as physicians, chiropractors, therapists with multiple specialties, hospitals, and durable medical equipment suppliers.

This program is designed to return money to self-insured groups by identifying and recovering benefit plan payments for medical services and supplies that have been inappropriately paid.

In the recovery phase, this program:

  1. Contacts the source of the suspected billing error,
  2. Provides specific billing error feedback,
  3. Solicits recovery of overpayments, and
  4. Returns net recoveries back to the self-insured group.

HRI's recovery process is supported by the coding system established by the American Medical Association and group fiduciary responsibilities enumerated under ERISA, the False Claims Act, and U.S. Mail Fraud.

HRI takes the requirements of the Health Insurance Portability and Accountability Act of 1996 ("HIPAA") and the associated regulations, 45 C.F.R. parts 160-164, as may be amended (the "Privacy Rule") and 45 C.F.R. 142.308(a)(2), as may be finalized and amended (the "Chain of Trust" requirement) very seriously. HRI is committed to upholding the highest security and privacy policies and procedures in the industry.

CPT is a registered trademark of the American Medical Association