It's no secret that healthcare fraud accounts for an estimated 100 billion dollars a year in the United States alone, and it's increasingly a reason that health care costs continue to rise. Unnecessary and fraudulent treatments are being submitted to payer organizations by organized crime and con artists have become big business in North America today. Increasingly, health insurance organizations are looking at new ways to detect, investigate and prosecute anyone submitting fraudulent health care claims.

An independent review organization plays an important role in helping healthcare fraud special investigative units investigate and determine whether claims are legitimate, whether chart notes support a legitimate case and whether medical necessity is associated with a case.

A doctor from independent review organization can quickly look at the charts involved in a claim and decide whether been documents were fraudulently submitted, whether the medical facts in the chart fit the claim and whether there's any up-coding or other tricks used by fraudulent claims submitters in order to get paid for treatments that weren't actually performed or even necessary.

Healthcare fraud is a problem in North America, yet gets very little attention in the news media. It is a problem that needs to be solved in order to reduce the cost of healthcare for all of us. Independent review organizations are playing an increasingly important role in reducing healthcare fraud by helping fraud special investigative units close fraud investigations and provide important insight about which cases should be paid and which shouldn't.