Case Study: Healthcare Partners Company recovers more than $1M in provider overpayments with Cotiviti's FWA solutions

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

Healthcare Partners Company, a not-for-profit managed care organization serving more than 258,000 Medicaid, Medicare, and CHIP members in Pennsylvania, faced the challenge of recovering suspected provider overpayments for upcoding — a process that required advanced statistical analysis, detailed medical record review, and careful case management. To become more proactive, the organization selected Cotiviti’s FWA Solutions, using Sentinel for automated detection, Informant for advanced data exploration, Commander to track caseloads and medical records, and Cotiviti’s SIU Services for external record review.

Cotiviti worked with Healthcare Partners Company’s SIU team to investigate alerts, run statistical sampling, review medical records, and present a well-documented case to the provider; Cotiviti also provided methodology and on-site support during negotiations. The effort led to a negotiated repayment exceeding $1 million (more than $500,000 for each of 2017 and 2018) via a payment plan, preserved the provider relationship with commitments to improved documentation, and reinforced Healthcare Partners Company’s confidence in Cotiviti as its FWA partner.