Fraud, Waste, and Abuse Mitigation Services
FWA Referral Management and Investigation
High-level review of FWA referrals and the associated case file documents to evaluate red flags and other case file information that may warrant further investigation. This initial review will result in a decision to open or not to open an investigation.
Investigation services include a wide array of activities such as:
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Informational and resolution interviews of policyholders, caregivers, and providers
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Vendor coordination (e.g., EVV analysis and investigation coordination)
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Field investigator/surveillance management
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Detailed social media and open source investigations and monitoring
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Investigation database support
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Overflow investigative management capacity
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Resolution strategy recommendations