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FRAUD, WASTE, AND ABUSE

Preparing your payment integrity programs for 2022 and beyond

The COVID-19 pandemic continues to place great burdens on our healthcare system. As providers responded to the added challenges, a few bad actors predictably took advantage of the outbreak to increase their reimbursement by upcoding, unbundling, performing unnecessary services, and billing for services not rendered. While fraudsters used many of the same schemes from before the pandemic, they also shifted targets to new areas of opportunity including phishing scams, telemarketing fraud, door-to-door solicitation, offering “free” testing or treatments, and identity theft.

As fraud, waste, and abuse persists during the COVID-19 pandemic, urgency increases for FWA detection and prevention among payers and vendors, whether it’s applying further prepay edits to stop inappropriate telehealth claims or rooting out testing and vaccination fraud through postpay approaches. But other challenges will continue to arise in 2022 and beyond. How can payers leverage what they learned from the past two years to create successful prevention plans in other areas unrelated to COVID-19? And what levers should they pull to help ensure that they’re more accurately predicting other types of FWA?

Join Cotiviti virtually for the 2021 National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference as we discuss this topic in our session on Predicting the Future: Preparing your PI programs for 2022 and beyond. By attending our session, attendees will:

  • Understand concepts and ideas of an effective retrospective analysis for identifying potential gaps that arose during the COVID-19 pandemic
  • Learn how to apply the lessons learned and move from a reactionary mode to more real time prevention of FWA
  • Get investigation tips and best practices for identifying future FWA schemes

Learn more

Don’t miss this opportunity to learn the latest billing trends and how consistent, agile analysis techniques can enable payers to stay ahead of future schemes. We look forward to seeing you there.

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 eight 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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