A medical insurance provider uses an electronic claims-submission process and suspects that a number of physicians have submitted claims for treatments that were not performed. Which of the following control procedures would be most effective to detect this type of fraud?
A) Require the physician to submit a signed statement attesting that the treatments had been performed.
B) Send confirmations to the physicians, requesting them to verify the exact nature of the claims submitted to the insurance provider.
C) Develop an integrated test facility and submit false claims to verify that the system is detecting such claims on a consistent basis.
D) Use computer software to identify abnormal claims based on the insured's age and medical history.
Correct Answer:
Verified
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