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.
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.