Though steps are being taken to fight healthcare fraud, there is much more that can be done. We are seeing new schemes and repeated fraud practices happening within provider networks throughout the country as we work with CMS and health plans to combat these violations. Through our network of over 550 licensed field and desktop investigators we are able to identify these situations before they become a major risk to the payors.
Ray Evans and Chandra Kuti will discuss the ever-evolving healthcare system involving state and federal regulations constantly changing along with the significant increase in utilization in the post-pandemic environment. They will review how this increase in claims volumes will effect the vulnerability for health plans and ways to identify any FWA issues that may be flying under the radar.
For over 20 years, CoventBridge Group has served as a Fraud, Waste and Abuse program integrity contractor for The Center for Medicare and Medicaid Services investigating Medical Provider FWA in Medicare, Medicaid, and commercial lines of business.
Armed with proven analytics utilizing over two decades of FWA expertise, enhanced with our proprietary algorithms and machine learning capabilities, our mission is to assist health plans in protecting their organizations from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.
Join our discussion on what the future holds for FWA and tactics to leverage the BIG Three --- identify – investigate – recover.
![](https://kisacoresearch.com/sites/default/files/styles/panopoly_image_square/public/speakers/ray_evans.jpg?itok=17yZNnQS&c=2b85be0ed9f33e03da23a140309452df)
Ray Evans
Ray Evans is a dynamic business development executive with extensive experience working within, and servicing healthcare organizations. He holds the position of Vice President of Healthcare Sales at CoventBridge Group where he utilizes his experience to share with the industry CoventBridge’s unmatched FWA investigative solutions. His goal is to work with health plans in protecting their organization from FWA through an experienced, flexible, and sensitive approach to minimizing provider abrasion, while still achieving organizational objectives.
![](https://kisacoresearch.com/sites/default/files/styles/panopoly_image_square/public/speakers/chandra_headshot.jpg?itok=cGWKeHMa&c=84e9cba5e8dc0192b9759e2df0f19692)
Chandra Kuti
CoventBridge
Website: https://coventbridge.com/
CoventBridge Group has more than 25 years of experience in the identification, prevention and investigation of fraud, waste, and abuse for our customers across the healthcare, insurance, financial and government markets with a proven track record of implementing and managing the largest programs in the industry. CoventBridge is the partner of choice supporting:
- 8 of the top 10 commercial carriers in the U.S.
- 7 of the top 10 personal line carriers in the U.S.
- Centers for Medicare and Medicaid Services as the Program Integrity contractor investigating Healthcare FWA
- One of the largest government agencies providing a national network of undercover investigators
CoventBridge offers the following services and more via its 500+ investigators:
Program Management
• Audits & Assessments
• Compliance Assessment
• Medicare & Medicaid FWA
• On-site Audits
• Vendor Management
Document Retrieval & Analysis
• Medical Record Retrieval
• Medical Record Review & Coding (RN)
• Investigative Medical Record Review
• Medical & Healthcare Canvassing
Investigative Services
• Healthcare FWA Investigations
• Investigative Reports
• Clinical Surveillance
• Law Enforcement Referrals
• Alive and Well Checks
Staff Augmentation
• Data Analysts
• Investigators
• Nurse Reviewers
• RN Consultants