Cotiviti

Today's the last day to stop by the Cotiviti booth at the 2024 NHCAA Annual Training Conference! Watch as Erin Rutzler chats with Warren Lesnefsky about 360 Pattern Review and major fraud, waste, and abuse trends we're seeing this year.

KFF recent employer health benefits survey reveals a complex issue for companies navigating PBM contracts and rebate structures. Among employers with 500+ employees, only 19% report receiving the majority of rebates, while a large portion—37%—remain unsure about the return of savings. https://bit.ly/3Y9sYAH HealthLeaders #HealthPlans #payments

As the demand for effective data exchange increases, so does the need for a strong healthcare interoperability program. The RISE Radio podcast dives into recent regulatory updates and offers practical guidance on using digital data to drive meaningful results in risk adjustment and quality operations. Cotiviti's Katie Devlin, DHSc, MS, CPHIMS, and Adam Gilbert discuss industry trends and how health plans can fine-tune digital data strategies. https://bit.ly/4hQwU2p #healthcare #interoperability

In 2024, employers shouldered the majority of rising plan costs, with the average family premium hitting $25,572, but most refrained from offering additional benefits like GLP-1 weight loss drugs. A KFF report shows that only a fraction of large firms covered GLP-1s, citing concerns about cost. https://bit.ly/3C2qNY2 Healthcare Dive #HealthPlans #healthcare #payments

With the Annual Election Period underway, now is the time to implement proactive, multichannel engagement strategies for Medicare Advantage members, which can drive retention, close care gaps, and enhance member satisfaction, leading to better outcomes. Watch our webinar on YouTube as Cotiviti's Leah Dewey and Becca Jones share the details on why member engagement is critical. https://bit.ly/3BHh7lD #HealthPlans #Medicare

Our team is standing by for you at NHCAA's Annual Training Conference in New Orleans! Stop by booth 415 in the Anti-Fraud Expo Hall to play Expert Eye, take home a travel kit, and support the Boys & Girls Clubs of America — all while learning how Cotiviti empowers health plans to prevent and manage #FWA with our dynamic solutions.

Fraud, waste, and abuse (FWA) continue to pose significant challenges in healthcare, eroding trust and costing billions annually. Notable Q3 2024 cases highlight the breadth of these schemes, including $40 million in alleged genetic testing fraud, $39.6 million in telemedicine-related false claims, and $32.7 million in unnecessary urine testing. Addressing FWA requires robust detection and prevention strategies to protect health plans and members from harm. Read more from Cotiviti's Erin Rutzler, vice president of fraud, waste, and abuse (FWA). https://bit.ly/4hWbTTF #FWA #HealthPlans

In 2025, payers can enhance care quality while managing rising costs. Innovations like AI are expected to improve network adequacy and streamline processes such as same-day treatment authorizations and claims payments. https://bit.ly/3A7ZoU4 Becker's Healthcare #HealthPlans #payments

Cotiviti’s Katie Devlin, DHSc, MS, CPHIMS, vice president of interoperability, joined the 2024 Fierce Health Payer Summit in Austin, Texas last week for a discussion on how payers can make meaningful progress toward electronic clinical data exchange amid TEFCA and other significant developments. Thank you to all who joined us!

The latest Medicare Advantage star ratings for 2025 reflect a continued decline in quality. Only 40% of plans received four or more stars, down from 42% in 2024 and a notable drop from 68% in 2022. Only seven plans earned five stars for 2025, a sharp decrease from 38 in 2024, highlighting a trend that may affect plan bidding and bonuses. https://bit.ly/4f0dMws Healthcare Dive #HealthPlans #payments