FWA Insights: Excessive dental restorations
Learn how Cotiviti's SIU identified excessive billing for dental restorations to safeguard payment integrity and appropriate member care.
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Fraud, Waste, and Abuse
Fraud, waste, and abuse (FWA) remains one of healthcare's greatest challenges. These resources from Cotiviti offer best practices to prevent and catch FWA.
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FWA Insights: Solving durable medical equipment (DME) challenges
Learn how Cotiviti's investigators took action when one provider stood out for excessive durable medical equipment (DME) billing of Medicare.
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Busted: The top fraud schemes of Q1 2025
Read our summary of how bad actors allegedly deployed kickbacks, false claims, and exploitation of vulnerable patients to defraud health plans in Q1 of 2025.
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FWA Insights: Skin grafts and substitutes
Learn how prepay FWA review identified over half a million dollars in skin substitute overpayments for one client.
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Busted: The top healthcare fraud schemes of Q4 2024
Some of the most prominent FWA cases of Q4 2024 included fraudulent billing, illegal kickbacks, and other misconduct that frequently jeopardized patient safety.
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Detect and deter FWA while meeting compliance and financial goals
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FWA Insights: Reducing audit abrasion
Learn how a more collaborative, transparent approach to provider audits can help health plans maintain compliance while fostering productive provider relationships.
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FWA Insights: Changes to audio-only telehealth codes sheds light on FWA
Learn how health plans can stay vigilant for FWA amid CMS’s changing telehealth guidelines.
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How to evolve your FWA program in 2025
Learn how payers can deploy technological advancements and machine learning alongside human expertise to reduce FWA.
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6 key capabilities to advance beyond traditional FWA lead detection
Learn six key capabilities health plans can incorporate into their FWA programs to maximize prevention, recovery efforts, and operational efficiency.
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Introducing Cotiviti's 360 Pattern Review™
Learn how Cotiviti's 360 Pattern Review offers comprehensive FWA prevention and management across the entire claim payment cycle, seamlessly integrating with your existing programs and personnel.
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Join the evolution: Advancing beyond traditional lead detection
Learn how your SIU can identify potential FWA sooner and eliminate wasted time spent on false-positive leads.
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Counteracting FWA in dental payments
Learn about common inappropriate dental billing practices and how dental payers can target them through automated solutions and clinical review.
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Busted: The top fraud schemes of Q3 2024
Physician fraud, genetic testing fraud, and fraudulent DME billing made up some of the most notable FWA cases in the third quarter of 2024.
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Highmark Wholecare prevents FWA with Claim Pattern Review
Learn how Highmark Wholecare prevented improper payments and FWA with Cotiviti's prepayment integrity solution.
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Program Integrity Pulse: Lessons learned from a successful prepay FWA program
Learn Highmark Wholecare’s strategy for preventing improper claims while seamlessly referring verified fraud leads to the SIU.
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FWA Insights: Catching outlier behaviors in physical therapy claims
Learn how Cotiviti’s SIU identified a physical therapy outlier and discovered patterns of inappropriate billing.
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Busted: The top fraud schemes of Q2 2024
Read a rundown of notable healthcare fraud, waste, and abuse cases, including a >$2 billion nationwide bust.
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Navigating new frontiers in FWA and payment integrity
Cotiviti's Erin Rutzler, vice president of fraud, waste, and abuse, explains how Cotiviti is empowering health plans to navigate new frontiers in payment integrity.
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FWA Insights: Analysis confirms >$1 million in improper claims
Learn how confirming a tip through data analytics yielded significant findings.
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Busted: The top fraud schemes of Q1 2024
Learn how some of the top healthcare fraud cases of Q1 2024 involved kickbacks, fabricated claims, and deceit of vulnerable healthcare consumers.
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