HealthElevate / Instruments / FWA False-Positive Cost Diagnostic
Decision Instrument · FWA Governance

FWA False-Positive Cost Diagnostic

As payer FWA controls tighten, false positives — legitimate care blocked or denied by blunt rules — become a significant cost in their own right. This instrument quantifies the cost of your current false-positive burden and assesses whether your control posture is optimised for the actual risk trade-off.

In Development — Available via Bespoke Engagement
Decision Question This Instrument Addresses
"Are we losing more money to bad denials than to fraud itself?"
What This Instrument Evaluates

Five Assessment Dimensions

Each dimension targets a specific failure mode that causes decisions of this type to go wrong. The instrument is designed to surface the gaps that are most likely to be consequential — not to measure maturity against an idealised standard.

Legitimate Care Blocked
What proportion of your denied claims represent clinically appropriate care that was refused due to rule-based pattern matching?
Provider Behaviour Distortion
Has overly aggressive FWA enforcement changed clinician behaviour in ways that reduce care quality or increase workaround costs?
Appeal & Administrative Cost
What is the true cost of your appeals process — including staff time, legal costs, and relationship deterioration — relative to fraud recovered?
Risk Trade-Off Calibration
Is your current control posture optimised for the actual fraud-to-false-positive trade-off, or is it set to an arbitrary threshold?
Feedback & Learning
Do denial outcomes feed back to your FWA control design — enabling systematic calibration rather than periodic manual review?
Instrument Output
Estimated false-positive cost · Risk trade-off curve · Optimal control posture recommendation
Typical Audience
CFOs, CMOs, Compliance Officers, Utilisation Management Directors

Available Now via Bespoke Engagement

This instrument is in development for standalone release. It can be applied immediately as part of a Full Diagnostic or Strategic Bundle engagement. Contact us to discuss your specific decision context.

Request This Instrument View Engagement Tiers
Related Instruments

You May Also Need

Live Instrument
VBHC Contract Stress Test →
Live Instrument
AI Deployment Governance Gate →