Case Study: Major Minnesota Health Planning Company achieves chiropractor conviction with Cotiviti's FWA Solutions

How a major Minnesota health plan built a strong case leading to a chiropractor’s fraud conviction

Major Minnesota Health Planning Company, a health plan serving more than 2.5 million members and processing over 40 million claims a year, faced a tip that a chiropractor was billing for services not rendered. The plan’s special investigative unit, which has relied on Cotiviti’s FWA Solutions for nearly 20 years, used Cotiviti tools — Informant, Sentinel and Commander — to triage leads, analyze claims data and manage the investigation.

Using Cotiviti’s Informant calendaring and reporting to pinpoint abnormal daily billing, Sentinel to identify aberrant provider patterns, and Commander to track case activity, the team built a law-enforcement-ready case that supported an onsite audit and records review. The investigation led to a wire-fraud conviction: the chiropractor pleaded guilty, was sentenced to 27 months in prison, ordered to pay hundreds of thousands in restitution, lost his license, and the probe exposed more than $1.7 million in suspect billings (including over $22,000 billed for 156 patients on a single day).