FWA Briefs

Find news and solutions for healthcare payers and providers. Recognize and avoid potential fraud, waste, and abuse scenarios. Real-time clinical claim editing are analyzed to maximize provider reimbursements.

Why Fraud Analytics Are Important to You

  • by John Danza
  • Oct 17, 2022, 11:17 AM
Man Working on Computer

The U.S. Department of Justice recently issued a press release about guilty pleas for people involved in a fraud scheme to perform unnecessary back surgeries (https://bit.ly/3CCUhJW). In this scheme, doctors, patients, and others were involved. The value of just this particular scheme is more than $31,000,000.

This scheme points out why Context 4 Healthcare does what we do, and why our fraud, waste, and abuse (FWA) solutions do what they do. This particular scheme has situations that could have been revealed through the use of Context’s FWA solutions. Specifically:

  • The doctor was performing surgeries that are typically outside of the capabilities of a provider with the specialty that they’re registered for. The Context FWA solution allows you to monitor providers performing services outside of their specialty in two ways.
    • First, the Context prepayment FWA solution identifies claims where the service provider on the claim is billing a service that is outside the norm for the provider’s specialty. You can prevent payment on the claim until you’ve checked medical records and are satisfied with the evaluation.
    • Second, the Context FWA analytics solution allow you report and extract on all claims in your book of business that a particular provider or a particular provider specialty is performing. You can then delve deeper into the aberrant situations.

       

  • The doctor was performing an unusually high volume of surgeries. The Context FWA analytics solution can be used to identify the abnormally high instance of procedures for a particular provider, showing the work to be outside the norm for those procedures.

     

  • The patients were in on the scheme. This is one of the reasons why the Context FWA solutions contain separate watch lists for both providers and members. Once an investigation begins, it’s important to put the parties on a watch list to prevent additional claims from processing unnoticed. The Context watch lists provide that capability, and also the capability to report on activities for those on the watch list.

Helping you keep an eye on your plan is what Context is all about. To learn more about our FWA solutions, visit us at www.context4.com.

<a href="https://air-purifier.bestairpurifiers.store/">hepa</a>
hepa Mon Jan 20 2025

True Hepa Filter Odor Allergies Eliminator Home Office

<a href="https://3m.vacuumguide.biz/">3m bags miele g n</a>
3m bags miele g n Mon Jan 20 2025

Cleaner Cu510, Cu512, Cu520 Part 207-3gt-6 \ Htd 207-3m

<a href="https://chatting.talkwithstranger.com/">chat ave</a>
chat ave Thu Jan 16 2025

Wow! This could be one particular of the most useful blogs We have ever arrive across on this subjec

Wow! This could be one particular of the most useful blogs We have ever arrive across on this subject. Actually Magnificent. I am also a specialist in this topic so I can understand your effort.
Read full comment

<a href="https://www.tickethold.com/concerts/jelly-roll-tickets/index.php">Jelly Roll Place</a>
Jelly Roll Place Tue Jan 14 2025

Invest in Jelly Roll in Edmonton tickets at Rogers Place on March 13, 2025 theater layout, balcony l

Invest in Jelly Roll in Edmonton tickets at Rogers Place on March 13, 2025 theater layout, balcony layout and rows.Read full comment

<a href="https://pensee.eyeglassesguide.biz/">pensee circle</a>
pensee circle Mon Jan 13 2025

Frames 54[]16 138 Green France S257

<a href="https://andoer.hdcamcorders.org/">andoer 4k</a>
andoer 4k Fri Jan 10 2025

Mini Police Body Camera 180 Video Dvr Ir Night Cam

<a href="https://fsa.bikesr.com/">fsa headset</a>
fsa headset Wed Jan 08 2025

Shimano 21 Speed Mens Bikes Bicycle Mtb

<a href="https://brantley-gilbert.ticketspowerhouse.com/">Brantley Gilbert Alliant Energy PowerHouse</a>
Brantley Gilbert Alliant Energy PowerHouse Wed Jan 08 2025

Own Brantley Gilbert in Cedar Rapids tickets at Alliant Energy PowerHouse on March 14, 2025 buyer, f

Own Brantley Gilbert in Cedar Rapids tickets at Alliant Energy PowerHouse on March 14, 2025 buyer, floor and reserved.Read full comment

<a href="https://stuffed-animal.stuffed-animals.org/">stuffed animal dog</a>
stuffed animal dog Wed Jan 08 2025

Realistic Cat Stuffed Animal 12 Inch Plush Cat Stuffed Doll

<a href="https://the-fab-four-the-ultimate-tribute.knoxvilletntickets.com/">The Fab Four The Ultimate Tribute Theatre</a>
The Fab Four The Ultimate Tribute Theatre Wed Jan 08 2025

Obtain The Fab Four - USA Meets The Beatles! in Knoxville tickets at Bijou Theatre - TN on September

Obtain The Fab Four - USA Meets The Beatles! in Knoxville tickets at Bijou Theatre - TN on September 12, 2025 venue, ticketing and code.Read full comment

<a href="https://parade.inglewood-tickets.com/">Parade Los Angeles</a>
Parade Los Angeles Wed Jan 08 2025

Obtain Parade in Los Angeles tickets at Ahmanson Theatre on July 12, 2025 lower deck, vividseats and

Obtain Parade in Los Angeles tickets at Ahmanson Theatre on July 12, 2025 lower deck, vividseats and verified.Read full comment

<a href="https://haaga.sweepersguide.biz/">haaga sweeper</a>
haaga sweeper Mon Jan 06 2025

NEW Haaga 31 Battery powered Triple Brush Push Power Swe

<a href="https://ariat.bootsmen.org/">ariat</a>
ariat Fri Jan 03 2025

S Brown Work Boots Size11

<a href="https://dti-car-audio.bestcaraudio.store/">dti speakers</a>
dti speakers Wed Jan 01 2025

Dtids1050mb4 10-inch Midbass Driver With 4 Ohm Impedance

Load more comments
comment-avatar

Subscribe to Our Blog:

Connect With Us

Authors


Proudly Affiliated with:

Proud_Members_Logo_250X100   National Association of Dental Plans Member   FedRAMP  Amazon Web Services