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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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Amid the challenges of providing care throughout the pandemic, telehealth has become a path through which patients can get the help they need with increased convenience and without exposing themselves to COVID-19. Payers, providers, and regulatory agencies worked together to help ensure that those in crisis would have access to the services they needed throughout the pandemic. However, as we navigate the present, payers should consider how these pandemic changes are affecting behavioral health claims today.

As the industry has continued to navigate the historic influx in behavioral claim volume, bad actors have been exploiting new possibilities within fraud, waste, and abuse (FWA). And as changes have been made to increase access, these bad actors have seen these added flexibilities as an opportunity for FWA.

In this white paper, we will:

  • Walk through the changes that have been made throughout the pandemic
  • Examine where weak points exist within behavioral healthcare claim payments
  • Explain how plans can both safeguard themselves and be confident in their own claim accuracy

About the Author

As vice president of fraud, waste, and abuse (FWA), Erin is responsible for the oversight and strategic direction of Cotiviti’s FWA solution suite. In her role, Erin has been integral in the development of Cotiviti’s FWA solutions over the past eight years. Serving as the company’s primary subject matter expert in investigations and FWA for compliance, client training, sales, and marketing activities, she regularly represents the company at industry conferences such as the National Health Care Anti-Fraud Association’s (NHCAA) Annual Training Conference (ATC).

Profile Photo of Erin Rutzler