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Clinical labs are increasingly under the regulators’ microscope

On Behalf of | Dec 15, 2017 | Health Care Investigations |

Where would today’s medical profession be without clinical labs? So much of proper diagnosis, treatment and prevention of illness are dependent on the tests conducted on blood, urine and saliva in those labs in New York and elsewhere.

Because the tests can be enormously profitable, competition among labs can be fierce. Regulators contribute to the pressure labs are under, looking for evidence of violations of the Anti-Kickback Law, as well as instances of self-referral and coding and billing discrepancies.

Clinical labs go under after improper billing allegations

A half-dozen clinical labs around the country declared bankruptcy last year following similar improper billing allegations by Medicare, it was reported. In one example, a lab was ordered to repay millions of dollars to Medicare for genetic testing that the federal agency deemed unnecessary. The business then went under.

In court documents, attorneys for the clinical lab said that the allegations stemmed from disagreements with the government over the merits of the tests that were provided. The court filing also blamed Medicare audits that retroactively rejected its billing.

More investigations could put New York clinical labs at risk

As the nation’s bill for testing climbs past $8 billion annually, regulators, insurers and others worry that testing is often about boosting the fortunes of labs, hospitals and doctors than it is about the health of the patients involved.

“Medicare shouldn’t be paying for dubious tests,” said a spokesperson for budget watchdog Taxpayers for Common Sense, “but the time to catch that is in the very beginning when (labs) are asking for payment. They need to increase oversight so the dollars don’t go out the door in the first place.”

If oversight is indeed increased, it will mean more investigations that can hamper business operations and cause irreparable harm to reputations. Experienced health care law attorneys can protect your rights and interests throughout the process.


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