Fraud, Waste and Abuse in Healthcare Claims: A Bad Situation Worsened by the Pandemic

Here’s what benefits managers should know about detection and prevention.

Whether it is deliberate or accidental, it is hard to deny that fraud, waste, and abuse (FWA) are running rampant in health care claims and contributing to the rising cost of health care. FWA brings real consequences to corporate benefits managers who have a responsibility to their stakeholders, including both corporate employers and their employees who demand continued quality of care options while trying to keep down costs, prevent sharp increases in rates and other out-of-pocket expenses.

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About the Author

About the Author

Prior to joining AArete, Maria began her career at Arthur Andersen where she provided audit and consulting services to privately-held companies in a variety of industries including the transportation, professional services and non-profit sectors. She subsequently served as the CFO for a provider of global brand management solutions. With nearly twenty years of consulting experience, Maria is a leader in AArete’s Healthcare Payment Intelligence™ practice with a focus on configuration and overpayment analytics, including Healthcare Fraud, Waste and Abuse (FWA) and other payment integrity issues. She works closely with leading insurance payers to design and implement comprehensive solutions that are customized to align with each client’s unique business requirements resulting in the early detection, recovery and prevention of overpayments in healthcare claims. She couples her depth of business knowledge with her expertise in healthcare to create innovative solutions that are tailored to meet the challenges healthcare payers currently face. Maria holds a Bachelor of Business Administration degree from The University of Iowa, is a Certified Public Accountant (CPA) and belongs to the Illinois CPA Society. Additionally, Maria serves as President Elect of the University of Iowa Professional Accounting Council, is an Executive Sponsor of AArete’s Women’s Initiative Network (WIN) and is also a member of the Women Business Leaders (WBL) of the U.S. Health Care Industry Foundation.