thinking inside the box: identifying FWA and taking action on high-risk providers

Verscend recently introduced a series of “Perspectives” on the concept of a provider decision quadrant to help health plans fine-tune the prioritization process when it comes to addressing potential fraud, waste, and abuse (FWA) in their provider networks. Our first Perspective introduced how the quadrant replaces the more traditional approach of simply examining the fraud likelihood score with one that also looks at paid-claim exposure. In our second Perspective, we performed a closer examination of providers who reside in the low-risk quadrants.

In our third Perspective on this topic, we zero in on the high-risk quadrants to determine how the provider decision quadrant influences plan anti-FWA activities for providers in these categories.

Download our third Perspective to learn more about the key metrics that define providers in these two high-risk quadrants and the critical action steps to take for each of them based on the level of billing activity.

accountable-care-organization health-insurer medicare-advantage-plan medicaid-agency no payment-accuracy none no fraud-detection none no no no no no reports no no no

view our perspective