AMG-SIU provides an array of health care claims editing services and fraud and abuse services. These services are offered separately or in combination according to your specific needs (See Program Options). While a few services must be combined, the remaining services are optional and may be provided by your existing staff (or ours) .

The preliminary investigation determines if a reported allegation or a provider or member identified from the data downloads has a basis for further investigation of a potential claim error, fraud, waste or abuse. A preliminary investigation is initiated for:

• All complaints received through the plan’s hotline or reported to its compliance officer.
• All providers identified in the initial history analysis.
• All providers or members detected through the AMG-SIU Automated Claims Evaluator (ACE) system from the prospective and retrospective download analysis.
• Providers identified through public sources for disciplinary actions by government agencies.