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FWA Insights: Q&A with the SIU

Author Heather Rickards, MS, AHFI, CFE

While prepay claim editing systems continue to grow more advanced, they can’t prevent every fraud, waste, and abuse (FWA) scheme from slipping through the cracks. That’s why a high-performing special investigations unit (SIU) must be powered by both human expertise and advanced analytics to sift through mountains of data and identify aberrant trends.

Here, we conduct a Q&A with some of Cotiviti’s own credentialed investigators to break down complex questions related to skin grafts and substitutes, agrowing area of FWAcapturing attention nationwide.

About the Author

With more than 20 years of experience combatting healthcare fraud, Heather analyzes claims data to identify potential instances of FWA and conducts investigations on behalf of private insurers. She led a team performing on-site laboratory inspections and investigations for newly created non-participating laboratories, presenting their findings to an FBI field office.

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