Healthcare Fraud, Waste, and Abuse Software
Identifying Suspicious Provider Billing Trends
Fraud, waste, and abuse can be difficult to prove. Virtual Reporter® helps your team isolate suspicious billing behavior, compare providers and specialties, quantify repeat issues, and determine where education, recovery, escalation, or investigation may be required.
Research Billing and Coding Trends in Minutes
Within Virtual Reporter®, your team can select an FWA reporting module, define the billing issue you want to investigate, choose the applicable timeframe, and analyze every provider and claim matching that scenario.
For example, you can compare new-patient evaluation and management codes against established-patient codes to identify providers billing higher-level new-patient services when established-patient services may have been appropriate. You can then rank providers by frequency and financial impact, export the findings to PDF or Excel, and narrow the analysis by specialty.
Analyze claims as far back as you wish
Rank providers by number of billing issues
Compare trends across specialties
Isolate one or multiple specialties for focused review
Export provider and claim findings to PDF or Excel
Assign targeted reviews to compliance or FWA personnel
Support provider education, correction, recovery, and escalation
Disclaimer: Virtual Reporter® identifies billing activity that may warrant further review. Your organization remains responsible for determining whether education, correction, recovery, escalation, or formal investigation is appropriate.
5 Reasons Healthcare Fraud, Waste, and Abuse is Increasing
Coding & Billing Complexity
More codes, modifiers, and rules create more opportunities for errors and abuse.
Claim-Level Only Reviews
Single-claim review misses patterns across providers, specialties, and time.
Rapid Network Growth
Larger networks make high-risk providers harder to identify quickly.
Limited SIU Staffing
Teams cannot manually profile every provider or investigate every trend.
Government Enforcement
Payers face more pressure to detect, correct, recover, and escalate.
Turning Claims History into Billing Trends
Establishing Network Wide Errors First
Fraud, waste, and abuse investigations rarely begin with a single claim. They begin with patterns across time. Virtual Reporter® allows your team to analyze historical claims, identify recurring billing behavior, compare providers and specialties, and progressively narrow the data until the most significant trends become clear.
Review the Entire Network →
Start with broad claims history across all providers, specialties, codes, and lines of business.
Identify the Billing Trend →
Select the behavior you want to evaluate, such as new-patient coding, modifiers, duplicates, unbundling, frequency, or global-period billing.
Narrow by Specialty or LOB →
Compare specialties, isolate the highest-impact groups, and determine which providers are driving the trend.
Drill Into Claims and Financial Impact →
Review the underlying claims, quantify frequency and dollars, export the findings, and determine the appropriate next action.
The FWA Process Simplified
Let's Get Started
Whether you already use Virtual Examiner® or are exploring PCG for the first time, we’ll help you identify the most practical path to VA Live.
The FREE Audit Process
45-55 Minute Consult
1-3 Days Claims Upload Completion
1-2 Week Audit Analysis by PCG
2-3-Hour Meeting for Results and ROI
1-Week Proposal and Licensing Review
No Hard sells, just facts and strategies
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