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OCI Analytic Uncovers Duplicate Billing in Over 4% Of Workers' Comp Claims

DENVER, July 2 /PRNewswire/ -- An analytic study by OCI found that over 4% of all workers' comp claims have a duplicate bill sent to a group health plan. OCI conducted the analyses on a large employer from their proprietary Reference Database on duplicate workers' compensation and healthcare payments. The purpose of the study was to determine how frequently and how much greater costs occur if and when providers are billing both workers' comp and healthcare for the same services, patient or claimant.

The results of the study were presented at a recent meeting of the Fraud Assessment Commission, under the California Department of Insurance Fraud Program. The study found the following:

  • 4.2% of ALL workers' comp claims have a duplicate healthcare claim
  • Over half of the duplicate claims filed received payment
  • The employer paid over $1.2 million dollars in duplicate payments
  • One-third of the duplicate claims filed were paid more than what was billed
  • The employer paid over $100,000 in overpayments on duplicate claims

"There is an occurrence of duplicate billing on the exact same workers' comp claim, same date of service, same ICD-9, same billing codes, same provider also billing to group health," says Archie Anderson, President of OCI. "This was an aged claim analysis, meaning all the payments have been made. This particular employer was not even aware."

The cause of duplication cannot be determined from the data, however the claim set is easily identified for follow up. To prevent duplicate claims, an employer or organization must commit to integrating its workers' comp and healthcare billing and claims data to identify where the duplicate billing and payments occur.

OCI's Information Management Solutions provides the data integration necessary to complete this analytic study for any organization or company. In addition, OCI also provides ongoing tracking and detection capability, which allows employers to stop duplicate payments before they are paid or recover overpayments sooner.

OCI's Workers' Compensation & Healthcare Duplicate Payments Analysis has been featured in greater detail by Workers' Comp Executive and Workers' Comp Central. For more information or to view these articles, please visit

About OCI - OCI is an information management solutions provider that helps companies make better-informed decisions about their risk management and employee benefit programs.

OCI has designed and delivered integrated health and productivity solutions to Fortune 1000 companies since 1984. Using secure web-based applications, a flexible, client-centric approach and deep industry experience, our solutions transform data into information and knowledge, giving our customers the power to increase administrative efficiency, reduce expenditures and improve productivity.

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