Learn the top dental procedures that are frequently misused as we examine their causes, consequences, and the steps necessary to mitigate the effects of fraudulent and abusive billing.
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Learn how Cotiviti's SIU identified excessive billing for dental restorations to safeguard payment integrity and appropriate member care.
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Learn how Cotiviti's investigators took action when one provider stood out for excessive durable medical equipment (DME) billing of Medicare.
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Read our summary of how bad actors allegedly deployed kickbacks, false claims, and exploitation of vulnerable patients to defraud health plans in Q1 of 2025.
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Visit NowLearn how prepay FWA review identified over half a million dollars in skin substitute overpayments for one client.
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Detect and deter FWA while meeting compliance and financial goals
Read fact sheetSome of the most prominent FWA cases of Q4 2024 included fraudulent billing, illegal kickbacks, and other misconduct that frequently jeopardized patient safety.
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Learn how a more collaborative, transparent approach to provider audits can help health plans maintain compliance while fostering productive provider relationships.
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Learn how health plans can stay vigilant for FWA amid CMS’s changing telehealth guidelines.
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Learn how payers can deploy technological advancements and machine learning alongside human expertise to reduce FWA.
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Learn six key capabilities health plans can incorporate into their FWA programs to maximize prevention, recovery efforts, and operational efficiency.
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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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Learn how your SIU can identify potential FWA sooner and eliminate wasted time spent on false-positive leads.
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Learn about common inappropriate dental billing practices and how dental payers can target them through automated solutions and clinical review.
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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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Learn how Highmark Wholecare prevented improper payments and FWA with Cotiviti's prepayment integrity solution.
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Learn Highmark Wholecare’s strategy for preventing improper claims while seamlessly referring verified fraud leads to the SIU.
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Learn how Cotiviti’s SIU identified a physical therapy outlier and discovered patterns of inappropriate billing.
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Read a rundown of notable healthcare fraud, waste, and abuse cases, including a >$2 billion nationwide bust.
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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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Learn how confirming a tip through data analytics yielded significant findings.
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