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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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: 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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Detect and deter FWA while meeting compliance and financial goals
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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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Busted: The top fraud schemes of Q4 2023
Some of the top alleged cases of healthcare fraud in Q4 2023 included falsified claims and exploitation of healthcare programs for Native Americans.
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FWA Insights: Examining a suspicious volume of HCPCS codes
Learn how overuse of HCPCS H2014 and HCPCS T1017 led to an FWA investigation by Cotiviti’s SIU.
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Preparing for 2024 trends in healthcare FWA: CPT code updates and beyond
Learn about critical updates to the 2024 CPT code set and other trends impacting healthcare payments.
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Medicare Advantage plan reduces inappropriate payments by millions with Claim Pattern Review
Learn how one Medicare Advantage plan prevented more than $1 million inappropriate payments in less than a year with Claim Pattern Review.
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Program Integrity Pulse: Preparing for investigative FWA strategies in 2024
Learn about 2024 CPT code updates that may increase the potential for FWA as well as other anticipated trends.
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Busted: The top healthcare fraud schemes of Q3 2023
Read about some of the most prominent alleged cases of healthcare fraud, waste, and abuse occurring during the third quarter of 2023.
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FWA Insights: Flagging suspicious activity related to COVID-19 testing
Learn how Cotiviti flagged one provider in 2023 for possible fraud, waste, and abuse (FWA) activity related to COVID-19 drive-through tests.
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FWA Insights: 6 areas of healthcare and how to defend them against fraud, waste, and abuse
Learn how your plan can tackle fraud, waste, and abuse across areas like DME, genetic testing, and more.
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Program Integrity Pulse: Finding new schemes with AI and investigative techniques
Hear from our FWA experts on how artificial intelligence (AI) and machine learning (ML) can be used to detect emerging patterns of inappropriate billing and how to navigate new technology challenges.
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Busted: The top fraud schemes of Q2 2023
Cotiviti rounds up some of the most prominent cases of alleged healthcare fraud from the second quarter of 2023.
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FWA Insights: Catching schemes related to Ozempic, Wegovy, and semaglutides
Learn the emerging schemes in the market related to the new drug.
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Program Integrity Pulse: A Claim Pattern Review case study
Learn how to integrate prepay and postpay program interventions to improve fraud, waste, and abuse (FWA) management and prevention.
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How to sequence FWA investigations for greater impact
Learn how health plans can structure their healthcare fraud, waste, and abuse investigations most effectively.
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FWA Insights: Flagging high-frequency telehealth claims
Learn how Cotiviti’s SIU investigated suspicious telehealth claim activity.
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