Improper billing practices and schemes related to urine drug screens (UDS) are common, requiring investigative resources to detect potential fraud, waste, and abuse (FWA). Though the Centers for Medicare & Medicaid Services (CMS) regulates human lab samples through strict guidelines outlined in the required Clinical Laboratory Improvements Amendments (CLIA) certification, some laboratories and testing facilities may lack up-to-date certifications, posing a risk to members and payers alike. As demonstrated in one recent investigation conducted by Cotiviti’s special investigations unit (SIU), with meticulous medical review and data mining, health plans can safeguard member care and help reduce improper billing.
Improper billing practices and schemes related to urine drug screens (UDS) are common, requiring investigative resources to detect potential fraud, waste, and abuse (FWA). Though the Centers for Medicare & Medicaid Services (CMS) regulates human lab samples through strict guidelines outlined in the required Clinical Laboratory Improvements Amendments (CLIA) certification, some laboratories and testing facilities may lack up-to-date certifications, posing a risk to members and payers alike.
As demonstrated in one recent investigation conducted by Cotiviti’s special investigations unit (SIU), with meticulous medical review and data mining, health plans can safeguard member care and help reduce improper billing.
