Lessons learned from a successful prepay FWA program

Register for our webinar on September 26 at 1 pm ET

As health plans increasingly adopt formal prepay fraud, waste, and abuse (FWA) programs, many still face challenges such as limited resources, unsatisfactory results, or uncertainty about where to begin. Join us for a session crafted to provide insightful help, featuring FWA experts from Highmark Wholecare and Cotiviti. We’ll share case studies and lessons learned from successfully launching an effective prepay FWA program that meets the needs of both payment integrity and SIU stakeholders.

In this session, you will gain:

A clear understanding of Highmark Wholecare’s strategy for preventing improper claims while seamlessly referring verified fraud leads to the SIU
Insights into the top areas of abuse that can be effectively addressed in the prepay stage
Practical guidance on reviewing providers that have been flagged using artificial intelligence and deterministic algorithms before claim payment

As an added benefit, the National Health Care Anti-Fraud Association (NHCAA) is offering one (1) Continuing Professional Education credit towards the AHFI^® designation to live attendees who complete the NHCAA attestation online.

Don't miss this opportunity to learn from industry leaders and strengthen your FWA efforts.

AHFI^®is a registered trademark of the National Health Care Anti-Fraud Association (NHCAA).

Presenters:

Jennifer Putt, Manager Financial Investigations & Provider Review
Highmark Wholecare

Jennifer is a certified fraud examiner with over 27 years’ experience in fraud, waste, and abuse. Her experience revolves around managing people; auditing fraud, waste, and abuse; and regulation enforcement.

Nikki Brody, Senior Investigator, Fraud, Waste, and Abuse
Cotiviti

Nikki is responsible for analyzing claims data to identify potential instances of fraud, waste, and abuse among providers. She has conducted both prepay and postpay FWA investigations on behalf of private insurers. Nikki has nearly two decades in the insurance industry with 13 years of experience combatting healthcare fraud.

	Lisa Cook, Supervisor, Fraud, Waste, and Abuse Cotiviti Lisa is responsible for medical record review supervision to ensure the accuracy, completeness, and compliance of medical records and claims with applicable regulations and guidelines. She has been working in both prepay and postpay reviews with Cotiviti for six years. She has also been a registered nurse for more than 30 years with experience ranging from critical cardiac care to case management and clinical documentation improvement.

Lessons learned from a successful prepay FWA program

Register for our webinar on September 26 at 1 pm ET

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