> I understand that you, or your system, adds items to patients' bills for tests that either have never been performed, or that have been performed unnecessaril

> I understand that you, or your system, adds items to patients' bills for tests that either have never been performed, or that have been performed unnecessarily. The first one would be illegal. You can't bill for things that were not done. The second one is a matter of interpretation : I do not judge whether it was necessary or not. If it was performed, I try to see how it logically could be argued, using the probability of finding matching evidence, that it was necessary given the case or preexisting conditions - and thus bill for it. > Is that the case, or does your system check what probably was performed, and makes sure that it wasn't left out of the bill? The third one, making sure things that were performed were not left out of the bill, is most of the work. The files are incomplete and it requires a probabilistic and interpretative approach, before sending in a human for fact checking. It's all about providing incentives. The billing rules are complex, but there is some logic in them, and physicians see that too - it change their behaviour. #3 and #2 will directly result in other physicians becoming very careful that everything which should have been performed was - because doing this is highly lucrative, "it is as good as printing money". No need to do anything but following the law and the billing rules. Truly useless tests won't increase the bill, and therefore they will be weeded out. I see that as a financial incentive to change behaviours.