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?
Using computer software to identify abnormal claims based on the insured's age and medical history would be the most effective control procedure. This approach leverages data analytics to detect patterns that deviate from expected norms, which is essential in identifying potentially fraudulent claims. Other options either rely on manual verification, which is less reliable and more prone to human error, or on testing the system itself without directly addressing the suspected fraudulent claims.
Why not C?