Case study: Highmark Wholecare prevents FWA with Claim Pattern Review
Fraud, waste, and abuse (FWA) requires a robust payment integrity program. From compliance requirements and coding accuracy to the added complexity of Medicaid state regulations, bad actors are always looking for ways to slip through the cracks for their own benefit. For smaller special investigations teams (SIU) dealing with a high volume of claims, extra support helps speed along the process of catching FWA, whether simple mistakes or signs of nefarious activity.
Read our recent case study to discover how Highmark Wholecare enlisted the help of Cotiviti’s prepay FWA solution, Claim Pattern Review, preventing more than $1 million in inappropriate spending in less than a year.
The case study walks through:
Discover how Highmark Wholecare’s experience led to better payment integrity and prevented improper claim payments.
About the author
As vice president of fraud, waste, and abuse (FWA), Erin Rutzler 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 ten 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).