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With an increased emphasis on cost containment and regulatory scrutiny leading up to reform, the need for health plans to shift from defensive to proactive engagement regarding fraud and improper payments is critical. SAS and Stonegate Advisors LLC interviewed executives at 13 of the largest U.S. health plans to gain insights into the current reality of fraud and improper payments and to review strategies and tactics that can be put in place in anticipation of reform. This paper explains the major trends uncovered in this research that signify a fundamental shift in health plans' approach to improper payments.
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