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FRAUD, WASTE, AND ABUSE

Maintaining a strong and successful SIU in 2023

Special investigations units (SIUs) are a health plan’s front line of defense against fraud, waste, and abuse (FWA). These highly specialized and credentialed teams typically comprise coders, certified fraud examiners, reporting and compliance specialists, and auditing experts. They primarily focus on auditing, detection, and investigation of potential FWA to ensure claims are paid correctly. SIUs also handle federal and state reporting requirements, collaborate with law enforcement, and oversee the plan’s case management system. This system allows the SIUs to track and report cases, build out corrective action plans, and vet incoming cases.

But maintaining a robust SIU team is costly, requiring intensive recruitment efforts, continuous training, and a strong retention program to help ensure that valuable staff don’t take their skills to a competitor—costing your organization valuable institutional knowledge in the process. These challenges are even more difficult for smaller health plans, where the entire SIU may comprise only one or two investigators who suffer from greater risk of burnout from large caseloads.

As the “Great Resignation” continues to impact health plan staffing and FWA cases persist across all types of healthcare claims, here are five tips to help your health plan retain SIU employees and foster team bonding.

SIU panel: Best practices in healthcare payer FWA

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Enhance your onboarding process and training

Improving onboarding and training is necessary to better your staff’s comfort and competence. By focusing on training within the first 90 days of team members’ onboarding and including a detailed onboarding checklist, one particular SIU saw better output from staff in handling cases and working independently. The checklist was especially crucial in ensuring the new employee completed all the necessary steps while having a sense of independence in the process.

Ensuring the SIU manager is available to answer the new employee’s questions is also essential to building trust and retention. Training should always foster growth and development, both personally and professionally. If organizations are investing in their staff, many will feel empowered and connected to their team and their employer.

Invest in specialized software systems

Many SIUs still perform manual investigation processes with cumbersome and rudimentary spreadsheet applications, which can wear down team members and lead to burnout. Implementing more specialized, tailored, and streamlined software solutions not only improves the efficiency and outcome of your investigations, but also reduces tedious work for your team and lowers the chance for fatigue.

Promote work/life balance for your team

Creating an environment that supports sound mental health is a key aspect of retention. One health plan SIU created ”Star Days,” wherein a staff member can receive an extra half or whole day off when needed to better balance their work and home life. Effective SIU leaders believe that as long as the work is completed in a timely and satisfactory manner, people should be able to focus more on their personal life.

Celebrate your team and build your connections

Celebrating life events and practicing team-building activities further benefits retention. While in-person events may lead to stronger connections, virtual meet-ups still offer a chance for team bonding. By celebrating birthdays, holidays, and anniversaries as a team, staff will build connections and stay longer. On a smaller scale, frequent team and individual recognition unites the team and uplifts morale. Sharing these recognitions out to the wider team also builds respect and camaraderie on your own team and throughout the wider organization,

Always be open to improvement

A simple way to improve retention is through a continuous improvement log, as suggested by one health plan SIU. Associates were tasked with submitting ideas to an improvement log on a regular basis for the management team to review and determine ideas for process and team improvements. By allowing staff to feel a part of the process and be heard, they will be more likely to stay within the team and organization.

Cotiviti’s SIU Services offer program integrity expertise to health plans through consultative support such as best practices consulting and investigative skills training. Learn how we can help augment your in-house teams or provide a complete outsourced solution.

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WRITTEN BY

Erin Rutzler
As vice president of fraud, waste, and abuse (FWA), Erin is responsible for the oversight and strategic direction of Cotiviti’s FWA solution suite. In her role, Erin has been integral in the development of Cotiviti’s FWA solutions over the past ten years. Serving as the company’s primary subject matter expert in investigations and FWA for compliance, client training, sales, and marketing activities, she regularly represents the company at industry conferences such as the National Health Care Anti-Fraud Association’s (NHCAA) Annual Training Conference (ATC).

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