Erin Rutzler, AHFI, CFE, CPC
Cotiviti, Vice President, Fraud, Waste and Abuse
Erin Rutzler is responsible for the oversight and strategic direction of Cotiviti’s FWA solution suite. In her role, Erin has been integral in the development of Cotiviti’s FWA solutions over the past eight years. Serving as the company’s primary subject matter expert in investigations and FWA for compliance, client training, sales, and marketing activities, she regularly represents the company at industry conferences such as the National Health Care Anti-Fraud Association’s (NHCAA) Annual Training Conference (ATC).
Increased scrutiny from regulators has made it even more challenging for special investigation units to recover losses due to fraud, waste and abuse. With tighter regulations regarding health insurers’ obligations to report and refer waste and abuse, cross-organizational collaboration with other payment integrity stakeholders has become even more important to maintaining successful FWA programs.
Cotiviti provides healthcare payers of all sizes with an end-to-end payment integrity solution called Cotiviti Payment Accuracy. We ingest our clients’ historical and real-time claim feeds along with other healthcare data one time to then apply the right payment integrity intervention at the right time: from prepay error and waste prevention in areas of coordination of benefits and professional claim coding to postpay identification and investigation of billing abuse or patterns of fraud. This supports cross-organizational payment integrity collaboration, connecting postpay to prepay processes for higher medical cost savings and greater efficiency while satisfying fraud and abuse regulations.
While most vendors specialize in one or two areas of payment integrity, Cotiviti provides a full and synergistic continuum of market-leading solutions that allow the right payment integrity intervention at the right point in the process. Integrated capabilities review all major claim types before they are paid to prevent as much as possible, then appropriately refer suspicious claims and/or providers/members for further review earlier in the process. Our postpay analytics and services are informed by any work already performed by our prepay services, making them more efficient and accurate. Conversely, postpay results help drive the continuous tuning of prepay analytics so that clients can push more postpay work to prepay.
Read our payment integrity case studies in success, like how a major New York health plan prevented more than $10.5 million by catching a diagnostic testing scheme very early in the process.