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PAYMENT INTEGRITY

Video: Preventing healthcare fraud, waste, and abuse before paying claims

Healthcare fraud, waste, and abuse (FWA) accounts for up to 10 percent of total healthcare spend—and the vast majority of those dollars are never recovered. While health plans try to prevent FWA before claims are paid, this carries unique challenges. Watch our latest video explaining how to successfully implement a pre-pay FWA approach without compromising valuable provider relationships.

 

Ready to see this approach in action? Our latest case study explains how a New York health plan worked with Cotiviti to realize more than $10.5 million in prospective savings after identifying a possible massive diagnostic testing fraud scheme. Download it to learn how the plan not only prevented inappropriate payments by placing several providers on pre-pay review, but compiled a compelling case to refer to law enforcement for prosecution.

Read the case study

By taking a proactive approach to FWA, health plans can identify potential patterns of FWA early in the process to prevent fraudulent claims from being paid while still meeting prompt-pay requirements.

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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