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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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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A house united: Integrating pre and postpay programs for optimal FWA results
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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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Detect and deter fraud, waste, and abuse while meeting compliance and financial goals
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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 pre-pay 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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Fraud, Waste, and Abuse (FWA) Validation solution
Prevent FWA before claims are paid and flag providers that warrant immediate investigation
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Fraud, Waste, and Abuse (FWA) Management solution
Detect and deter fraud, waste, and abuse (FWA) while meeting compliance and financial goals
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Cotiviti SIU Services
Investigative and clinical support for health payers
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