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医療保険会社は電子請求提出プロセスを使用しており、多くの医師が実施されなかった治療の請求を提出したと疑っています。この種の詐欺を検出するには、次のどの制御手順が最も効果的ですか？
A. 統合されたテスト機能を開発し、システムが一貫してそのようなクレームを検出していることを確認するために虚偽のクレームを送信します。
B. 治療が行われたことを証明する署名入りの声明を医師に提出するように要求します。
C. コンピューターソフトウェアを使用して、被保険者の年齢と病歴に基づいて異常な主張を特定します。
D. 医師に確認を送信し、保険プロバイダーに提出された請求の正確な性質を確認するように依頼します。
Answer: C
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Answer:
Explanation:
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Answer: A,D
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