Busted: The top fraud schemes of Q1 2022
Learn about the latest indictments related to healthcare fraud, waste, and abuse (FWA) targeting both public and private payers.
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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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Catching potential drug testing fraud%%Watch the on-demand webinar
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Rising telehealth: Catching FWA in behavioral health claims
Discover how the pandemic has affected behavioral health claims and learn different tactics for avoiding fraud, waste, and abuse.
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Detect and deter fraud, waste, and abuse while meeting compliance and financial goals
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Specialty Drugs: Ensuring payment accuracy beyond prior authorizations
While many plans lean on prior authorizations to ease the processing of specialty drug claims, our experts explore more comprehensive options for getting claims paid more accurately—and more quickly.
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Busted: The top healthcare fraud schemes of Q4 2021
The top alleged healthcare fraud schemes in the fourth quarter of 2021 came in the form of kickbacks, falsified claims, overbilling, and more.
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What’s old is new again: 3 healthcare fraud trends to watch for in 2022
Here are three common schemes special investigative units (SIUs) should expect to see persist in 2022 and how to combat them.
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A house united: Integrating pre and postpay programs for optimal FWA results
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Busted: The top healthcare fraud schemes of Q3 2021
The most nefarious alleged healthcare fraud schemes of Q3 2021 included drug testing schemes, kickbacks, money laundering, and more.
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Busted: The top fraud schemes of Q2 2021
From fraudulent COVID-19 tests to fake requests for durable medical equipment (DME), this spring was full of attempts to defraud healthcare payers. Here, we’ve gathered some of the most...
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Busted: The top healthcare fraud schemes of Q1 2021
While 2021 has brought renewed optimism over the COVID-19 pandemic, it has also delivered numerous new fraud, waste, and abuse (FWA) cases in healthcare.
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Case study: Identifying potential fraud, waste, and abuse during the COVID-19 pandemic
While the COVID-19 pandemic has challenged providers in significant ways, it unfortunately has also created new opportunities for a small handful of bad actors to take advantage of the...
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Research: Optimizing payment integrity with enterprise pre and postpayment solutions
Cotiviti surveyed health plan leaders to investigate the challenges their organizations are facing with balancing prospective and retrospective payment integrity programs.
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Reduce FWA in 2021 with a proactive approach
Cotiviti's senior leaders explain how to guard against healthcare fraud in 2021 amid recent CPT code updates coupled with permanent regulatory changes to telehealth.
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Advanced analysis and collaboration drives $1M+ overpayment recovery success for Health Partners Plans
Learn how Health Partners Plans of Pennsylvania successfully recovered more than $1 million in overpayments related to upcoding from a provider group in partnership with Cotiviti.
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Coronavirus FWA: What health plans need to know
As payers ramp up their efforts to manage the coronavirus (COVID-19) outbreak, it’s important they stay alert of possible fraud, waste, and abuse (FWA) schemes.
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How to identify and stop emerging COVID-19 fraud schemes
As the COVID-19 pandemic continues, fraudsters have adapted their behavior to circumvent ongoing investigations and fraud detection. As a result, health plans may be vulnerable to new schemes.
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New York health plan cracks massive diagnostic testing scheme for prepay FWA savings
Learn how a major New York health plan worked with Cotiviti to realize more than $10.5 million in savings from one major investigation.
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Busted: the top COVID-19 healthcare fraud schemes
The COVID-19 pandemic has created opportunity for bad actors to exploit vulnerabilities in the healthcare system—as well as capitalize on fear. From offering phony testing to peddling...
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Taking a prepay approach to FWA
Learn best practices for preventing healthcare fraud, waste, and abuse, avoiding the need to "pay and chase" when fraudulent payments occur.
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8 tips to help you find the FWA needle in the haystack with Excel
We’ve created a checklist with eight practical tips that will help you navigate Excel efficiently and spot potential trends during your FWA investigations.
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How a major Minnesota health plan built a strong case leading to a chiropractor's fraud conviction
Learn how a Minnesota payer serving more than 2.5 million members caught a chiropractor's fraudulent scheme and reported it to law enforcement.
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Busted: The top healthcare fraud schemes of Q4 2020
Numerous bad actors in healthcare continued to be at large in 2020, exploiting the COVID-19 health crisis and taking advantage of health plans and their members. In Q4, healthcare fraud...
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