Experts to discuss emerging home health fraud schemes and showcase innovations driving FWA prevention

Cotiviti, a leader in data-driven healthcare solutions, will attend the 2025 National Health Care Anti-Fraud Association (NHCAA) Annual Training Conference, November 18–21, 2025, in Nashville to showcase 360 Pattern Review™, the next evolution of fraud prevention and management. Cotiviti will also be presenting at the event on fraud, waste, and abuse (FWA) in home health and personal care services.

“As healthcare fraud, waste, and abuse schemes continue to exploit vulnerabilities in claims payment, payers are finding it increasingly difficult to keep pace with limited special investigations unit (SIU) resources and false-positive leads, making it harder to safeguard their members and protect their plan benefits,” said Erin Rutzler, AHFI, CFE, CPC, vice president of FWA for Cotiviti. “Compounding these challenges, many organizations are cautious about adopting new FWA solutions due to potential disruption to their existing teams and systems. We look forward to meeting with health plans at the NHCAA Annual Training Conference to demonstrate how they can strengthen their fraud prevention and management processes without displacing their existing staff and workflows.”

360 Pattern Review unites Cotiviti’s proven prepay Claim Pattern Review™ with its postpay FWA Pattern Review™ to deliver comprehensive, continuous fraud detection across the payment continuum. Drawing on more than 25 years of experience and partnerships with over 45 payers, Cotiviti identified nearly $19 billion in suspected FWA claims last year.

Supported by a team of more than 75 credentialed analysts and advanced machine-learning driven analytics, 360 Pattern Review helps payers detect fraud earlier, reduce false positives, and boost SIU productivity, all while supporting rapid recoveries. By integrating prepay automation with postpay investigation, Cotiviti creates a closed-loop system where insights flow both ways, enabling faster detection of emerging schemes and stronger fraud prevention end to end.

“Cotiviti’s vision is to enable a high-quality and viable healthcare system by leveraging innovative solutions that not only detect and prevent FWA, but also foster long-term sustainability for payers and members alike,” said Rutzler. “With tools like 360 Pattern Review, Cotiviti is actively advancing its mission by helping to ensure that valuable healthcare resources and benefits are preserved for those who need them most. By driving accurate claims payment and supporting efficient, compliant operations, Cotiviti helps safeguard member benefits and promote trust throughout the healthcare continuum.”

Cotiviti, a platinum sponsor of the 2025 NHCAA Annual Training Conference, will present on fraud, waste, and abuse in home health and personal care services for Medicaid, Medicare, and dual-eligible members on Wednesday, November 19, from 10:30-11:30 am CT.

During the session, FWA experts Megan Brennan, CPC, CPCO, CPMA, CFE and Heather Rickards, MS, AHFI, CFE will unpack the nuances of home health services and equip SIUs with strategies to curb FWA, improve provider compliance, and focus resources on member care. FWA experts will also be on-hand in booth #816 demonstrating Cotiviti’s FWA Pattern Review solution. For more information and to sign up for a demo, visit the Cotiviti website.

About Cotiviti

Cotiviti enables healthcare organizations to deliver better care at lower cost through advanced technology and data analytics that improve the quality and sustainability of healthcare in the United States. Cotiviti’s solutions increase transparency and collaboration between payers and providers while empowering them to reduce medical and administrative costs, enable better health, improve claims payment efficiency, streamline operations, drive interoperability, and advance value-based care. Its customers serve the majority of U.S. healthcare consumers, providing coverage and care for over 300 million members and patients. Additionally, Cotiviti offers data management and recovery audit services to the retail sector to improve business outcomes. For more information, visit www.cotiviti.com.

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“With tools like 360 Pattern Review, Cotiviti is actively advancing its mission by helping to ensure that valuable healthcare resources and benefits are preserved for those who need them most."