Catching potential drug testing fraud: A case study of successful investigative techniques

As the opioid epidemic continues to ravage the nation, it leaves opportunity for bad actors to exploit the crisis and maximize their reimbursement. Opioid drug testing is an especially ripe area for exploitation and while these schemes are not new, many of them can go undetected for years due to the siloed nature of claim data across health plans.
Watch our on-demand webinar, Catching potential drug testing fraud: A case study of successful investigative techniques, featuring Cotiviti and MetroPlus Health Plan. We will discuss our collaborative case study of a New York laboratory provider identified through data analysis and its association with a previously indicted pain management provider. Through a joint effort, Cotiviti and MetroPlus Health Plan’s information sharing, link and peer comparison analyses, and a medical review of records, we were able to identify an overpayment of more than $1,000,000.
In this on-demand webinar, participants will learn to:
-Leverage information sharing and conduct link analysis to examine relationships and connections with known bad actors
-Utilize peer comparisons to identify outlier providers
-Perform a thorough medical review to generate the audit findings report