Fraud, waste, and abuse (FWA) costs the healthcare system billions of dollars annually for a number of reasons. Inappropriate or fraudulent claims are often paid due to overwhelmed and insufficient staff, disparate record systems, incomplete data sets, and mandated processing efficiencies. Postpayment efforts typically result in recovery of 60–70% of verified waste and abuse—and just 5% of fraud.
In contrast, when Cotiviti’s Claim Pattern Review solution verifies a claim as being associated with waste, abuse or error, 100% of the incorrect payment is preventable. Claim Pattern Review analyzes prepay claims and other data points to identify suspicious patterns of FWA and prevent inappropriate claims from being paid while still meeting prompt-pay requirements. Our solution also flags suspicious providers that warrant immediate investigation, helping special investigations units (SIUs) build ironclad cases to stop bad actors sooner. Claim Pattern Review works in tandem with Cotiviti’s other prepay claim review solutions and postpay FWA pattern detection solutions.
Join Cotiviti for the 2022 NHCAA Annual Training Conference and learn what it means to be certain amid unrelenting changes in healthcare.
Cotiviti’s FWA solutions empower healthcare payers to:
Stop by our booth and see how Cotiviti can help you prevent errors, waste and abuse while identifying fraud sooner, delivering both medical and dental cost savings. We look forward to seeing you there!
Attend our speaking session and grab your “golden ticket” from our team and we’ll enter you into our raffle to win a $250 airline gift card!*
Stop by our booth to play Cotiviti Word Hunt and receive a FEED tote bag!* FEED’s mission is simple—to feed children across the globe. Each bag provides 10 school meals to children in the most vulnerable populations. Complete the form on this page and we’ll set one aside for you at our booth.
*Note: Open to non-vendor, health plan attendees only. Limit of one raffle entry per attendee. View full Giveaway Rules.
By definition, healthcare fraud is the intentional deception to secure unfair or unlawful gain. As such, alleging fraud requires that payers spend months if not years of work to prove intent, which cannot be addressed within prompt-pay deadlines of 45 days or less. So what exactly is FWA prevention the industry talks about so much? In this session, our experts will use examples of FWA trends to explain how a combination of claims-based and provider-centric reviews both post-payment and prepayment can help prevent waste and abuse while minding strict fraud compliance guidelines.
Attendees will:
Jennifer Putt, CFE
Manager, Special Investigations Unit, Highmark Wholecare
Jennifer Putt is the Manager of Special Investigations Unit (SIU) at Highmark Wholecare. Jennifer’s healthcare career has spanned over 25 years, including 18 years working on the provider side in various leadership and auditing roles. Her experience revolves around managing people and auditing specific to fraud, waste, and abuse and regulation enforcement.
Ryan Cleverly, AHFI, CSPO, MCS
Product Director, Fraud, Waste, and Abuse, Cotiviti, Inc.
Ryan Cleverly is responsible for the strategic direction of Cotiviti’s FWA product offerings, including both postpay and prepay FWA detection. He previously worked as a criminal investigator investigating allegations of all types of insurance fraud and was part of a federal healthcare task force focused on provider fraud.
Ed McCormick, AHFI, CFE, CPC
Client Services Manager, Fraud, Waste, and Abuse, Cotiviti, Inc.
Ed McCormick provides oversight for one of Cotiviti’s clients that is contracted for both postpay and prepay FWA products. Ed has extensive experience in the healthcare fraud investigative industry. Previously, Ed worked as a supervisor of, and investigator within, other insurance payers, where he was responsible for investigating allegations of healthcare fraud. Ed has experience presenting healthcare fraud findings to both government and private industry interests.
