Fraud Management Solutions

Utilizing claims data analytics, Medicare, Medicaid and payer rules, CPT Code analysis, medical evidence based criteria, and business entity management intelligence, we engineer solutions to detect fraud patterns, abusive billing practices, over –utilization and misrepresentation of services provided, we work with payers to identify, manage and prevent fraud.

Our fraud management services include:

• Fraud Identification Data Collection
• Fraud Data Validation
• Clinical Fraud Pattern Detection
• Prepay Review
• Post Pay Review
• Litigation Evidence Preparation
• Expert Witness Preparation
• Legal Team Preparation

We have Special capability to handle to complex and addiction and sober living cases

Our FWA Mission

We partner with payers and their SIU teams to:

• Produce value added billing and service specific analysis , reviews and consultation.
• Analyze CPT code utilization with clinical documentation, conduct medical necessity evaluation, analyze fraud alerts, and develop evidence based fact driven tools to support the SIU team in the execution of their work.
• Be a reliable source of continuous consultative support and education to the payers and their SIU teams on medical management, healthcare business practices and fraud trends.
• Provide tools required to fight case.

Our Team

Our team is specifically prepared for the task. They are not only trained in medical reviews and analysis but they are also trained in:

• Medical billing and coding.
• Integration or CPT code analysis with clinical documentation and medical necessity determination.
• Fraud identification, detection and investigation.