tci Medicare Compliance & Reimbursement - 2022 Issue Q3

Fraud & Abuse: Federal Enforcers Fixate on Clinical Labs

Ensure your lab claims are medically necessary — or pay the price. Your practice likely orders clinical tests daily because they often lead to more informed diagnoses and enhanced treatment plans. However, recent enforcement suggests the feds are ramping up their scrutiny of clinical labs, and the penalties are steep. Background: The Department of Justice (DOJ) in collaboration with the HHS Office of Inspector General (OIG) has vigilantly pursued clinical lab fraud over the past few years, and it’s only increased during the pandemic. In fact, enforcement activity points to a federal spotlight on COVID-19 testing, experts warn...

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