When instances of fraud, waste, and abuse (FWA) are discovered, typical health plan actions include education, placing a provider on prepay review, pursuing settlement and recovery, or making a criminal referral—but determining the right steps to take and when can be a tricky process. Investigations require teamwork, compliance, and ultimately provider behavioral change to rectify wrongdoing. So how can health plans most effectively measure positive behavioral changes when FWA cases are validated?
Here are some steps you can take to improve FWA prevention and management in your organization.
