Forensic AI Alerts on Healthcare Fraud Trends

This guide compiles the monthly Forensic AI Alerts published by Codoxo during 2023, focusing on fraud, waste, and abuse (FWA) trends in healthcare. The alerts aim to provide healthcare insurers, agencies, and pharmacy benefit managers (PBMs) with timely information about potential FWA schemes that could impact their billing practices and financial health. The document includes chapters addressing various topics such as audio-only telehealth services, weight loss prescription drugs, asthma treatments, and billing practices related to colonoscopy and superficial radiation therapy. Each chapter outlines coding and billing guidelines, identifies suspicious billing trends, and discusses best practices for managing FWA. The guide serves as a resource for healthcare leaders to navigate the complexities of the U.S. healthcare system and address the challenges posed by evolving FWA trends and regulations. The objective is to enhance understanding of the healthcare landscape and improve cost containment strategies for health plans and providers.