OIG Releases Special Fraud Alert: Laboratory Payments to Referring Physicians

Many physicians and other healthcare providers refer a high volume of patient specimens to third party clinical laboratories every day. The Office of the Inspector General (OIG) for the U.S. Department of Health and Human Services recently issued a Special Fraud Alert that addresses these relationship between labs and physicians. The OIG’s Alert focuses on laboratories that may be violating the Federal Anti-Kickback Statute (AKS) in an effort to win business from referring physicians. OIG’s chief concern is that physicians will do business with the lab that pays the most, rather than the best lab, and that physicians will order tests that are not medically necessary, particularly if the payment arrangement is tied to the number of referred tests. The OIG focused on two types of arrangements that they fear pose a substantial risk of fraud and abuse, including (1) specimen collection and processing, and (2) registry arrangements.  Blood-Specimen Collection, Processing, and Packaging Arrangements (OIG notes this also applies to urine specimen and buccal swabs) Physicians’ offices often collect, process, and ship patient specimens to clinical laboratories that offer diagnostic testing. The process for storing and shipping this sensitive material may include centrifuging the specimen, keeping it at a certain temperature, and packaging the specimen. Some diagnostic laboratories enter into arrangements with physicians to compensate them for the time and effort involved i...
Source: Policy and Medicine - Category: American Health Authors: Source Type: blogs