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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.
FWA Case Management
Management of FWA cases includes a wide array of activities such as:
Informational and resolution interviews of policyholders, caregivers, and providers
Relationship mapping and link analysis
Vendor and investigation coordination
Field investigator management
Detailed desktop and open source investigations and monitoring
Investigation database management and reporting
Complex case file analysis
Overflow investigative support
Resolution strategy recommendations
FWA Capability Assessment / FWA Scan
Review organizational FWA identification and mitigation capabilities with a focus on people, processes, and technology. Assessment includes evaluation and establishment of goals and action plans to develop a customized FWA mitigation program. The FWA Scan includes review and analysis of targeted claims files to determine if FWA mitigation is warranted.
Remote or in-person FWA awareness training for essential personnel including claims examiners, managers, call center representatives, and investigators. Interactive training sessions are designed to educate attendees on the importance of an ongoing culture of awareness and their roles in FWA identification and mitigation. Training sessions focus on best practices, processes, and strategies to help identify and mitigate FWA and incorporate actual case studies.
FWA Program Management
Client-customized FWA program management includes development of long term and tactical program strategies, tailored reporting on program activities and results, and ongoing program support and coordination.
FWA Program Consulting
Consulting services include a wide-variety of support for client-managed FWA programs, including development, enhancement, and implementation of an FWA operating model. Our experts will identify case management tools, LTCi-specific analytic models, strategies, and workflows needed to achieve a successful program, and will provide project management and support services to implement recommendations.
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