ELEVATEGENETICS LANDSCAPE TM is an anti-billing fraud service that compares a lab's use of billing codes to their tests' technical components. Some laboratories commit billing fraud by using billing codes for technologies that their tests aren't capable of.

• From a billing perspective, such laboratories are billing for tests they have failed to deliver.

• From a quality of care perspective, such laboratory fraud can also be a potential source of false negatives.

Here are some technology-based fraud schemes CGI has already seen:

• The use of gene-specific billing codes when the laboratory's sequencing methodology does not reliably cover the billed-for gene(s).

• The use of molecular pathology codes that are specific to technologies the laboratory does not use.

• The use of deletion/duplication DNA sequencing billing codes when the scope of the laboratory test does not include deletions/duplications in its reporting.

ELEVATEGENETICS LANDSCAPETM

Sample Reports

Note to Payors: When screening vendors to construct a preferred laboratory network, or conducting post-payment audits, ELEVATEGENETICS LANDSCAPE is often the best service for payors to start with. A startling number of laboratories simply cannot do what they are billing for.

Contact CGI to learn more.