Fraud, Waste and Abuse Management Services for Health Plans
Safeguard Your Organization from The Growing Challenge of FWA in Healthcare
In the ever-evolving healthcare landscape, protecting your organization from financial losses due to FWA is paramount. Our comprehensive FWA solution is designed to detect, prevent, and mitigate fraud, waste, abuse, and overpayment risks, ensuring the financial integrity of your organization.
Healthcare fraud, waste, and abuse have resulted in staggering financial losses for the industry. Recent reports from the White House estimate a loss of $10.7 billion over the past three years. Detecting potential FWA incidents within massive amounts of data presents a significant technical challenge for health plans and law enforcement agencies. To compound the issue, those involved in FWA continuously evolve their methods to avoid detection, leading to continued financial losses for the industry. As a result, health plans are actively seeking solutions to detect, investigate, and prevent FWA incidents to mitigate these losses.
Our Comprehensive FWA Management Services
Access Healthcare's FWA Services offer a comprehensive solution to healthcare providers, payers, and law enforcement agencies. Our solution includes:
Fraud Detection and Prevention
Leveraging sophisticated data analysis tools and techniques, we proactively identify patterns, anomalies, and suspicious activities that may indicate fraudulent behavior. Our team works closely with you to implement robust fraud prevention measures, minimizing financial losses and reputational damage.
Abuse Mitigation and Compliance
We assist you in identifying instances of abuse, such as unnecessary medical procedures or billing irregularities, and help you implement proactive measures to prevent further abuse. Our services ensure compliance with regulatory guidelines, reducing the risk of penalties and legal repercussions.
Overpayment Identification and Recovery
Our advanced analytics and comprehensive review processes enable us to identify potential overpayments accurately. We conduct thorough investigations to determine the root causes of overpayments and implement recovery strategies to help you recoup lost revenue.
Value Proposition
At Access Healthcare, our FWA solution offers a range of benefits for payers, including:
Enhanced Claim Payment Accuracy: Our customizable FWA scoring engine, tailored to each payer's payment policies, ensures accurate claim payment and compliance with public and private program mandates. This helps reduce the risk of financial losses due to FWA and improves overall claim payment accuracy.
Cost-Effective Model: By utilizing effective FWA detection and investigation techniques, we help you maximize financial returns and reduce healthcare costs. Our solution identifies suspicious behavior, provides recovery services for overpayments, and implements preventive measures, resulting in significant cost reductions.
Customizable Dashboards and Reporting: Our solution includes dynamic reporting capabilities and customizable dashboards that enable you to monitor key process indicators in real time. This empowers you to identify trends, and potential issues, and take proactive measures to address FWA concerns efficiently.
Expert Support and Testimony: Our team of solution experts possesses deep domain knowledge and stays up-to-date with the latest developments in FWA prevention, overpayment recovery, and detection. We provide ongoing support, research, and, if required, expert testimony to support legal proceedings related to FWA and overpayment cases.
With Access Healthcare's FWA Services, you can protect your organization's financial integrity, optimize revenue, and reduce financial losses due to FWA and overpayments. Our comprehensive solution, backed by advanced analytics and a team of experts, enables you to detect, prevent, and recover from FWA incidents efficiently.
Contact us today to learn more about how our FWA Services can benefit your organization.
Our dedicated professionals are ready to assist you in implementing effective strategies, safeguarding your organization against FWA risks, and securing your financial future.