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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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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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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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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Detect and deter FWA while meeting compliance and financial goals
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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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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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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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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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