Are Your Laboratory Services Compliant?

What would the state of healthcare in this country look like without laboratory services? Considering that the country’s providers leverate lab tests as a common tool when diagnosing a medical condition, it would be an understatement to say that our ability to deliver healthcare would be severely hamstrung. But, what happens when providers order lab tests too frequently? Or, when whether or not the lab tests ordered are even medically necessary?

The University of Miami recently found the answer to those questions. According to court filings, the Department of Justice alleged that three University of Miami (UM) practices violated the False Claims Act. The filings further state that UM Hospital Facilities engaged in improper billing. As a result of these allegations, they were ordered to pay $22 million to resolve allegations that it violated the False Claims Act.

While Medicare regulations allow medical systems to convert physician offices into Hospital Facilities, they are also required to meet certain requirements. Which is understandable, given that billing as a Hospital Facility is more expensive to Medicare and its beneficiaries.

In the case of UM, the DOJ alleged that they converted multiple physician offices to Hospital Facilities, then sought payment at higher rates. All without providing their Medicare beneficiaries the required notice, or meeting certain other requirements.

But UM is not alone. With the rise in laboratory testing - both as a result of COVID-19, and as a common practice for diagnosing patients - the government has begun putting a sharper focus on how organizations are managing their laboratory services, and investigating more and more potential cases of false claims violations, regardless of the size of the laboratory.

If your organization submits claims to lab testing, I invite you to join us for our upcoming webinar, “How the DOJ’s Crackdown on Lab Testing Could Impact You,” hosted on Wednesday, July 21 at 1 PM ET, where I’ll be examining:

• Case Studies of Recent Laboratory Testing Enforcement
• Risks Your Medical Laboratories May be Exposed to
• Best Practices Your Compliance Program Can Adopt to Ensure Compliance

Be sure to join the live event, so you can be eligible for a free 1.2 HCCA-certified CEU credit. Hope to see you there!