FWA Insights: Flagging suspicious activity related to COVID-19 testing

The early days of the COVID-19 pandemic presented a host of new challenges for proper coding and billing. During this time, quick changes led to many innocent errors, but also created an opening for bad actors looking to exploit the pandemic for their own profit. Among them, COVID-19 drive-through tests, a life-saving measure for diagnosing and advising the public, was too often used as a nefarious tool for profit. While this type of testing is no longer prevalent today, many health plans have look-back periods stretching as far back as three years, and special investigations units (SIUs) continue to investigate data related to such potential schemes.