FWA Insights: Preventing overbilling in therapeutic home services

The risk of overbilling for therapeutic services remains a pressing concern for health plan special investigative units (SIUs) and compliance teams. Excessive or inappropriate billing not only drives up costs but can also undermine the integrity of care delivery. Identifying outlier procedure codes—like those billed at unusually high rates compared to peers—is a vital step in detecting and preventing fraud, waste, and abuse (FWA). By leveraging data analytics and targeted investigative practices, health plans can pinpoint these outliers and safeguard payment accuracy for home health claims.