Detection is no longer the key problem.
Sometimes what appears to be fraud is actually a case of inadvertent billing error. Criminals who defraud The Guardian and other healthcare payors are as savvy and as well-trained as the average health care industry employee. They understand health care financing and how the industry is organized, delivered, and paid for. The product supports massive claims databases enabling users to conduct statistically relevant studies and prepare reports with sufficient detail to justify and support settlement proceedings or, when appropriate, prosecution. More than 2,000 Guardian agents distribute Guardian products nationwide.