Statistical Sampling is an effective tool in Healthcare FWA Investigations, and here are the regulations, resources and court cases to prove it.
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When was the last time you took a step back to evaluate the effectiveness of your fraud, waste and abuse (FWA) program?
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This Valentine’s Day, we have decided to share some vendor neutral love with our technology vendor friends. Check out our Love Letter to Technology Vendors to learn 5 lessons that we think can help you build a better presence in the FWA industry.
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For many small to mid-sized health plans, the Special Investigations Unit (SIU) or FWA Program reports to a Compliance executive. In those situations, it can sometimes be a challenge to prioritize meeting the many SIU objectives and responsibilities, in addition to health plans compliance needs.
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ACA Enrollment is on the rise, and sadly, so is the fraud. So, what is happening and how do we mitigate the issues?
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In a victory for the FCA, the Supreme Court recently rejected an attempt to shift the knowledge standard in FCA cases that would have gutted the FCA.
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With the expiry of the Covid-19 Public Health Emergency (PHE) as of May 11, 2023 at 11:59pm, healthcare is slowly getting back to “normal”. With rules and regulations ever shifting, it can be hard to determine what’s the new normal, and detecting Fraud Waste and Abuse (FWA) can be a moving target.
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SIU Outsourcing has a ton of flexibility and can help the SIU unlock tremendous efficiency.. However, some perceive it as a threat. Read our article to understand the 4 most common myths of SIU outsourcing and how dispelling these myths can greatly benefit your organization.
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When health plans are looking for new technology capabilities to fight fraud, waste and abuse, specialized consulting can be a great help. This article outlines three key criteria to consider when navigating the maze of fraud detection options.
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