1. How do I know the participants submitted claims were valid / not medically feasible paid / not?

Are claims filed claims have anything to do with the business / factors which include the exemption of payment of claims, for example:
a. There are exceptions suicide,
b. Someone tried to make suicide attempts and failed then broken bones, and hospitalization, by informing the hospital that he fell from the motor.
c. Claims filed to replace the landfill with hope, because our medical team to know that medically, fractures due to fall from the motorcycle and fell from a height are different, then the landfill can identify the lies of the information provided participants, which led to the landfill does not recommend the Company to pay participant claims it.
3. What is the role of monitoring the landfill in inpatient participants


What factors can make our reply reference to see the feasibility of a health service provider agencies as a provider landfill?