• Skip to main content
  • Skip to footer

SmartLight Analytics

Reducing healthcare costs for self-funded employers

  • The Problem
  • The Solution
    • Frequently Asked Questions
    • Testimonials
  • About Us
    • Jobs at SmartLight
  • News & Blog
    • Whitepapers
    • SmartLight Blog
    • Press Releases
    • Case Study Fort Worth
  • Contact

August 19, 2019 By SmartLight News Desk

Phantom billing: Can you spot it in your claims?

Three seemingly unrelated imaging providers based in FL were identified in a self-funded employer’s medical claims for what was later verified as phantom billing.


The utilization patterns seen in paid claims history for an employee and his wife indicated a strong probability of “phantom” billing – billing for services never performed. Phantom billing typically involves setting up fake corporation(s) with the intent of billing non-rendered services. The individuals involved with the phantom corporations will then recruit patients by offering them an incentive in exchange for allowing their insurance to be billed.

Patients will also be offered incentives to recruit other members of the same insurance plan. Phantom providers start and stop billing within a short period of time in order to avoid detection.

Share this:

  • Twitter
  • Facebook
  • LinkedIn
  • Print

Filed Under: costs, healthcare Tagged With: claims, phantom billing

ambulance architecture building business

Inappropriate ER use has gone from serious to critical

November 1, 2021 By Franklin Baumann, MD

Correcting ER overuse has the potential for substantial cost reductions for employers and improved health outcomes for employees.

Who’s Watching the Money?

October 28, 2021 By SmartLight News Desk

Examining exactly where healthcare dollars are spent is not just a budget management or cost-saving practice for business, as plan sponsors are reminded often, it is also a fiduciary responsibility under the Employee Retirement Income Security Act (ERISA).

SmartLight Analytics opens new Plano, TX headquarters

September 16, 2021 By SmartLight News Desk

SmartLight Analytics opens its new Plano, Texas, headquarters this week beginning a new chapter for the growing team of data and clinical experts working to help self-funded employers to reduce healthcare spending by identifying and eliminating fraud, waste, and abuse in healthcare claims.

Footer

4965 Preston Park Blvd. Suite 350
Plano, TX 75093
Phone: 214-501-1046
Fax: 214-501-1208

About Us

SmartLight Analytics combines the best inferential analytic models with a team of analytic  and clinical experts to find fraud, waste, and abuse in self-funded employer health care plan claims data.
Learn More >

Connect

  • Email
  • LinkedIn
  • Twitter
SmartLight Analytics has been named finalists in D CEO Magazine Excellence in Healthcare Awards 2020 for Outstanding Service Innovation.

Copyright © 2023

  • The Problem
  • The Solution
  • About Us
  • News & Blog
  • Contact
Close