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Order with caution: The legal risks of non-compliant lab testing for physicians

On Behalf of | Mar 6, 2024 | Physicians & Physicians Groups |

Imagine standing at the crossroads of patient care and federal law, where every decision you make carries weight beyond the immediate health outcomes. For physicians, ordering laboratory tests is a routine part of diagnosing and managing patient care, but it is also an area fraught with potential legal pitfalls that could jeopardize your freedom, your practice, and the trust you have cultivated with your patients.

The recent indictment of Dr. Alexander Baldonado — facing charges for his role in a $20.7 million healthcare fraud scheme — underscores the gravity of compliance. It is important for physicians to use this case as a reminder to always remember that the seemingly straightforward process of ordering diagnostic and lab tests can become a legal minefield if not navigated with care.

What are the rules?

Physicians must follow federal and local regulations or can face fierce consequences, including the potential for criminal conviction. Physicians can reduce this risk by being aware of the following legalities:

  • Physicians must be aware of how the Anti-Kickback Statute and Stark Law guide their practice.
  • Always remember that ordering tests or services that are not medically necessary can result in allegations of wrongdoing.
  • Receiving kickbacks for referrals can lead to severe penalties.

The last one is often complicated by the fact that we continually push for collaborative care to benefit patients. It is important for physicians to carefully review their practices and billing agreements to better ensure they are able to work together with other professionals and avoid allegations of a violation.

What happened in the Baldonado case?

The government recently released the indictment for Dr. Baldonado and alleged involvement in a scheme costing the government over $20.7 million in fraudulent Medicare claims. The prosecution claims the physician received kickbacks in exchange for ordering unnecessary lab tests.

If convicted, he could face significant prison time.

Physicians can learn from his error. Important lessons from the case include:

  • Only order tests that are medically necessary.
  • Ensure all referrals are based on patient need, not financial incentives.
  • Maintain thorough documentation of all tests and services provided.

The legal implications of non-compliance in healthcare are serious and far-reaching. Physicians must stay informed and vigilant, not only to protect their practices but also to uphold the trust placed in them by their patients and the community.

It is also important to note that those who face similar allegations of wrongdoing have options. An attorney can review your case and discuss strategies to better ensure you reach the most favorable resolution possible.

Attorney John Rivas is responsible for this communication.

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