HEALTH PLAN FWA SOLUTIONS
Identify, Prevent, and Fight Healthcare FWA.
CoventBridge Group’s industry leading expertise in revenue recovery and compliance, combined with our deep understanding of the need to maintain and improve provider relationships, enables us to successfully balance these competing priorities while delivering a valuable return to our health plan clients.
For over 20 years, the CoventBridge team has served as an FWA contractor for CMS investigating Medical Provider Fraud, Waste, & Abuse in Medicare, Medicaid, and commercial lines of business.
Strong roster of data analysts for prospective & retrospective reviews, Certified Coder Registered Nurses for clinical review and a national network of licensed investigators, along with in-house legal and clinical resources.
Experienced, flexible, and sensitive approach to preventing provider abrasion, while still achieving client objectives.
Use Cases:
Program Management
Audits & Assessments
Compliance Assessment
Medicare, Medicaid & Commercial FWA
On-site & Desktop Audits
Vendor Management
Document Retrieval & Analysis
Investigative Medical Record Review
Medical Record Retrieval
Medical Record Review & Coding (RN)
Medical & Healthcare Canvassing
Investigative Services
Alive and Well Checks
Clinic Surveillance
Healthcare FWA Investigations
Investigative Reports
Law Enforcement Referrals
Staff Augmentation
Data Analysts
Investigators
Nurse Reviewers
RN Consultants
Services:
Credit Balance Audits
Data Analysis
Desktop Audits
Document Scanning
Facility Inspections
Field Investigations
Healthcare Fraud Investigations
Investigative Medical Review
Law Enforcement Referrals
Medical Record Retrieval & Review
On-site Audits
Payment Recovery
Pharmacy Audits
Pre-payment & Post-Payment Reviews
Provider Education
Site Verifications
Surveillance
Turn-key SIU Programs
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Insurance Solutions
From claim referral to resolution, we provide one convenient place for comprehensive and full-service fraud investigations.
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Government Solutions
Our government anti-fraud solutions are focused on program integrity and effectively safeguarding the public trust.
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International solutions
We are backed by an international team of 500 foreign investigators, serving more than 700 company clients in over 100 countries world-wide.
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