fraud, waste, and abuse prevention

Busted: The top healthcare fraud schemes of Q4 2020

Numerous bad actors in healthcare continued to be at large in 2020, exploiting the COVID-19 health crisis and taking advantage of health plans and their members. In Q4, healthcare fraud schemes included exploitation of telemedicine services, abuse of patient data, and multiple kickback schemes. Take a look at some of the top stories we’ve rounded …

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Podcast: Dr. Emad Rizk on managing telehealth concerns amid COVID-19

The extraordinary increase in telehealth usage during the COVID-19 pandemic has opened the door for potential healthcare fraud, waste, and abuse (FWA), particularly around upcoding. Cotiviti CEO Emad Rizk, M.D., recently appeared on the Healthcare Financial Management Association’s (HFMA) Voices in Healthcare Finance podcast to discuss the contributing factors, such as inappropriate levels of care …

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Case study: Identifying potential fraud, waste, and abuse during the COVID-19 pandemic

While the COVID-19 pandemic has challenged providers in significant ways, it unfortunately has also created new opportunities for a small handful of bad actors to take advantage of the outbreak to increase their reimbursement. Here’s how Cotiviti recently worked with MetroPlus Health Plan in New York City to identify inappropriate claims.

Q&A: Highmark’s payment integrity director on new COVID-19 claim trends

Cotiviti’s Signature Series features interviews with senior health plan leaders on how to improve clinical and financial outcomes in healthcare. During the COVID-19 pandemic, health plans have seen claim volume drop markedly, coding guidelines change regularly, and new care models such as telehealth burgeon. All this change occurring in fewer than six months has forced …

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Busted: the top COVID-19 healthcare fraud schemes

The COVID-19 pandemic has created opportunity for bad actors to exploit vulnerabilities in the healthcare system—as well as capitalize on fear. From offering phony testing to peddling “cures” for the virus, there seems to be few limits to what potential fraudsters might try. With help from the National Health Care Anti-Fraud Association (NHCAA), we’ve rounded …

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Video: Preventing healthcare fraud, waste, and abuse before paying claims

Healthcare fraud, waste, and abuse (FWA) accounts for up to 10 percent of total healthcare spend—and the vast majority of those dollars are never recovered. While health plans try to prevent FWA before claims are paid, this carries unique challenges. Watch our latest video explaining how to successfully implement a pre-pay FWA approach without compromising …

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