As healthcare fraud, waste, and abuse (FWA) schemes continue to evolve, the tactics deployed by health plan special investigations units (SIU) must evolve, too. That’s why Cotiviti is excited to share a new approach to tackling FWA in dental and healthcare payments at the 2024 National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference coming up this week in New Orleans.
Here's what you’ll learn as we delve into the hidden costs and challenges of FWA and introduce solutions that pave the way for improved payment integrity in healthcare.
Introducing 360 Pattern Review: A new era in FWA prevention
This year’s NHCAA conference is where Cotiviti will launch the innovative 360 Pattern Review solution, a comprehensive tool combining advanced prepay fraud detection with postpay insights to help healthcare payers prevent and recover more FWA while streamlining the claims review process. Powered by an AI-driven analytics engine, 360 Pattern Review identifies suspect claim patterns across the payment cycle, enabling teams to reduce inappropriate payments and increase efficiency without disrupting existing systems.
As healthcare costs and medical loss ratios continue to climb, this solution transforms how payers manage FWA, leveraging robust provider scoring models and lead vetting by subject matter experts to benefit members, providers, and the industry overall.
Combating FWA in dental payments
FWA costs the U.S. healthcare system hundreds of billions annually, with dental FWA contributing a significant portion. Cases of overtreatment, such as unnecessary crowns or root canals, add up to substantial financial losses for dental payers, and the resulting administrative burden of audits and investigations further drives up premiums for policyholders.
Steven M. Canfield, DDS, Cotiviti’s senior dental director, will join a discussion Wednesday, November 20 at 11:30 am CT on “Counteracting FWA in Dental Payments,” covering how issues like overtreatment and upcoding can drive up premiums, impact patient trust, and ultimately strain dental plans. Dr. Canfield will be joined by Thomas Redd, DDS, MS of Delta Dental of Arkansas, and others, in highlighting real-world examples and sharing innovative methods to catch these practices before they impact patient costs.
Stop by Cotiviti’s booth at NHCAA to learn more about these solutions and discover how we can help you strengthen payment integrity and reduce the impact of FWA on your organization. Just complete the form at the link below to sign up for a demo, and we’ll thank you with a pair of Loop Experience 2 Earplugs*.
We’ll see you at booth #415!
*Note: Open to non-vendor health plan attendees only; giveaways and raffles are limited to one per attendee. View Giveaway and Raffle Rules.
