FWA Insights: Prepay review leads to >$100K in projected annual savings

Behavioral health claims continue to be an area ripe for fraud, waste, and abuse (FWA) within the healthcare continuum—and health plans continue to see more of them. In a recent study by the American Psychological Association, 79% of surveyed psychologists reported an increase in the number of patients with anxiety disorders since the start of the COVID-19 pandemic. Despite small decreases in demand for anxiety and depression treatment compared with 2021, demand remained high for behavioral treatments generally, with continued increases in certain trauma- and stressor-related disorders observed.

Catching FWA within behavioral health claims can be challenging due to the nature of the services performed, since many treatments include talk therapy and other services that can be hard to quantify. However, the process can often start with something as simple as finding a suspicious code. This is exactly what happened for one Cotiviti client, leading to projected annual savings of approximately $115,000 from a single provider.