Screening identifies fabricated exposure histories, diagnoses unsupported by underlying records, claims for deceased or unlocatable individuals, and identity misuse. Methods include record verification, database matching, and pattern analysis across submissions.
Suspected fraud may be referred for further investigation.
Alternative Names:
Fraud Screening, Claim Fraud Detection
Why it Matters?
Documented fraud in mass tort programs has drawn congressional attention and judicial findings in several proceedings, which makes screening a defensible expenditure rather than an accusation. Pattern analysis is more productive than individual review, since fabricated claims frequently share characteristics such as identical exposure narratives, the same physician supplying diagnoses across many claimants, or clustered submission timing. Verification against independent records is the reliable method.
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Related terms
Frequently asked questions
What patterns indicate potential fraud?
Is screening defensible?
