Webinar: Reducing FWA through partnership

Cotiviti Blog · 19 hrs ago · 7 views

Fraud, waste, and abuse (FWA) risks are becoming more complex as health plans work to reduce improper spend, strengthen oversight, and move beyond traditional pay-and-chase models. For many organizations, sustainable prevention requires more than isolated investigations or retrospective recoveries. It depends on a coordinated strategy that brings payment integrity and special investigative unit (SIU) teams together around shared goals and action. Health plans are increasingly focused on building payment integrity programs that can identify suspicious patterns sooner, reduce administrative burden, and protect plan resources while supporting provider relationships and member outcomes. That means using both prepay and postpay insights to create feedback loops that help teams learn from emerging issues to apply those lessons earlier in the claim lifecycle. With personalized data, teams can make more informed decisions about when to review, educate, deny, or refer.

Fraud, waste, and abuse (FWA) risks are becoming more complex as health plans work to reduce improper spend, strengthen oversight, and move beyond traditional pay-and-chase models. For many organizations, sustainable prevention requires more than isolated investigations or retrospective recoveries. It depends on a coordinated strategy that brings payment integrity and special investigative unit (SIU) teams together around shared goals and action.

Health plans are increasingly focused on building payment integrity programs that can identify suspicious patterns sooner, reduce administrative burden, and protect plan resources while supporting provider relationships and member outcomes. That means using both prepay and postpay insights to create feedback loops that help teams learn from emerging issues to apply those lessons earlier in the claim lifecycle. With personalized data, teams can make more informed decisions about when to review, educate, deny, or refer.