AI Alert October 2025

The Add-On Epidemic: Fighting Fraud, Waste, and Abuse Beyond the Pandemic

When COVID-19 testing became routine, some laboratories began attaching high-cost “add-on” laboratory tests. While the public health emergency may have ended, the billing patterns it created for some providers have not. In December 2022, the Office of Inspector General (OIG) released a review of Medicare Part B data for COVID-19 tests that identified high volumes of additional laboratory tests were billed in addition to the COVID-19 testing.

The Department of Justice has charged several laboratories and medical providers for medically unnecessary add-on laboratory tests such as respiratory pathogen panels and genetic tests; creating “custom profiles” that automatically triggered physicians to order excessive testing, regardless of the patient’s actual condition; and/or billing for services that were not actually provided.

Table 1 includes examples of add-on tests:

Add-On Test	Purpose	Typical Concern
Respiratory Pathogen Panels (RPP)	Detects multiple respiratory pathogens	High-cost; often added routinely instead of symptom-based
Genetic Testing Panels	Assess hereditary or metabolic risks	Rarely justified alongside viral testing
Allergy Panels	Detect allergic sensitivities	Not clinically related to viral infection
Streptococcus (Strep) Tests	Identify bacterial throat infections	Often added routinely instead of symptom-based

Clinical Guidance

The Infectious Diseases Society of America (IDSA) released updated guidelines in October 2025 for diagnosing strep throat to help combat overtreatment and testing. These guidelines include discussion, evidence and considerations used to identify patients that may require laboratory testing.

While COVID-19 and strep throat share overlapping symptoms such as fever and sore throat, key differences can help clinicians distinguish between the two:

COVID-19: Viral; often involves cough, congestion, and shortness of breath.
Strep Throat: Bacterial; presents with white patches on tonsils, swollen lymph nodes, and painful swallowing – typically without cough or nasal congestion.

Routine ordering of strep tests with COVID-19 testing, without symptom-based justification, may signal potential abuse.

Indicators that may signal improper laboratory billing

Certain billing behaviors may indicate potential fraud, waste, and abuse [FWA]:

Identical test combinations appearing across a high percentage of the provider’s patient population
Routine billing of COVID-19 tests with add-on labs such as RPPs, genetics, allergy, and strep
Average per-patient payment notably higher than their peers
Duplicate testing – performed both at the point of care and by an outside laboratory
“Custom profiles” or standing orders that encourage mass ordering of unrelated tests
Unbundled billing for individual laboratory tests that should fall under panels for COVID-19 testing

How Fraud Scope can assist in identifying potential FWA with laboratory services

Fraud Scope includes query capabilities and advanced analytics that are critical in proactively identifying suspicious patterns. Below are a few features that can assist in identifying laboratory providers for additional review.

AI pattern recognition, outlier detection, and peer analysis
Unusually high volumes of laboratory tests
Frequent combinations of laboratory codes billed excessively higher than a provider’s peers
Outlier detection by comparing providers to peer norms by procedure code
Query Builder to create specific audit scenarios

FWA in laboratory testing remains a significant challenge. Pairing these analytics with targeted audits and clinical validation will help ensure inappropriate billing is caught early.