Case Study: Health Partners Plans achieves over $1M in upcoding overpayment recovery with Cotiviti's FWA solutions

Advanced analysis and collaboration drives >$1 million overpayment recovery success for Health Partners Plans

Health Partners Plans, a not‑for‑profit managed care organization serving more than 258,000 Medicaid, Medicare, and CHIP members in Pennsylvania, needed a proactive way to detect and recover provider overpayments—especially complex upcoding—beyond relying on tips. The plan selected Cotiviti’s FWA Solutions, using Sentinel, Informant, Commander and Cotiviti’s SIU Services for integrated data mining, advanced statistical analysis, medical record review, and case management.

Cotiviti detected aberrant E&M billing, guided sampling and statistical analysis, reviewed medical records and cataloged findings in Commander, and joined Health Partners Plans in provider meetings to present the evidence. As a result, Cotiviti’s work helped secure a settlement of over $1 million in repaid overpayments (more than $500,000 each for 2017 and 2018) via a payment plan, while strengthening the plan’s ongoing audit capabilities and provider documentation practices.

Health Partners Plans

Christian Sondergaard

Director