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EASING THE SEARCH FOR THE NEEDLE IN THE HAYSTACK USING DATA’S RED FLAGS

In the absence of fraudulent providers confessions, data analysis is the backbone of successful FWA investigations. As technology advances, so too does the creativity of unscrupulous providers, suppliers and fraudsters willing to exploit and misuse healthcare payer systems to gain improper payments. To continuously keep up, an ability to recognize red flags across various provider data sets is essential for today’s program integrity investigators. This session explores effective techniques for spotting red flags and using associated data analysis techniques, and detecting FWA across various provider specialties from different angles including pooling data, and use of public records and publicly-available data.