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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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Cotiviti’s prospective FWA Validation solution analyzes prepay claims and other data points to identify potential patterns of FWA and prevent those claims from being paid while still meeting prompt-pay requirements. Our solution also flags suspicious providers that warrant immediate investigation, helping special investigative units (SIUs) build ironclad cases to stop bad actors sooner.

  • Rapid ROI through automated detection while meeting prompt-pay laws
  • Projected savings of 0.3% of annual professional claim spend
  • Potential fraud cases identified earlier
  • Increased SIU staff productivity without displacing current resources or systems