Fraud, Waste & Abuse

Fraud, Waste and Abuse

Fraud, Waste and Abuse (FWA) costs health plans and drug plans operating in the Medicare, Part D, Medicaid and Commercial spaces billions of dollars a year. The schemes become more prevalent and the thieves more cunning every day. Fraud is an organized business and Plans need to stay ahead of the curve to stem the losses. ATTAC Consulting Group (ACG) assists Plans through evaluation of FWA programs, providing guidance on program design and implementation.

ACG leads Plans through evaluation of FWA program elements including:

External FWA:

• Evaluation of claim data mining methods and application of technology

• Evaluation and guidance in staff training, including customer service representatives

• Special Investigation Unit functions and processes

• Case documentation

• Regulatory and law enforcement agency interfaces and reporting

Internal FWA:

• Risk assessments

• Cost allocation validation and model review

• Claim and financial systems control review

• Regulatory reporting review

• Internal audit protocols

• Internal reporting and investigation