Fraud, waste, and abuse (FWA) schemes involving diagnostic testing continue to evolve, often leveraging complex coverage rules and aggressive outreach practices. Colon cancer screening kits, while clinically valuable when used appropriately, have increasingly appeared in investigations tied to excessive billing, insufficient documentation, and questionable ordering practices. In this edition of FWA Insights, we examine how Cotiviti’s investigators identified outlier billing patterns from one provider, what their investigation discovered, and how health plans can recognize signs of FWA in home screening tests.
Fraud, waste, and abuse (FWA) schemes involving diagnostic testing continue to evolve, often leveraging complex coverage rules and aggressive outreach practices. Colon cancer screening kits, while clinically valuable when used appropriately, have increasingly appeared in investigations tied to excessive billing, insufficient documentation, and questionable ordering practices.
In this edition of FWA Insights, we examine how Cotiviti’s investigators identified outlier billing patterns from one provider, what their investigation discovered, and how health plans can recognize signs of FWA in home screening tests.
