Medicare is the largest payer for clinical laboratory services in the United States, spending more than $7 billion annually for laboratory tests. To ensure this money is spent appropriately, the Health and Human Services’ Office of the Inspector General (OIG) continuously monitors payments to check for “suspicious” billing practices.

But what does “suspicious” look like? Where are the critical risks? How do you prevent an audit of your laboratory?

Those are the issues that Gregory Root, Esq., and Charles Root, PhD, co-chief operating officers of the consulting firm CodeMap in Schaumburg, Illinois, will discuss during their 1-hour webinar June 29 from 2-3 p.m. Eastern. Vince Stine, PhD, AACC’s director of government affairs, will moderate the discussion.

“Lab directors and others need to stay informed of the developing risk areas and recent enforcement actions,” said Gregory Root. “Knowing the focus of the OIG and the Department of Justice will help lab managers avoid potential civil and criminal liability.”

Billing practices and financial arrangements particularly vulnerable to OIG review, he said, include:

  • Inappropriate use of procedure codes to report drug testing/toxicology
  • Compensating physicians for specimen collection
  • Compensating physicians for sham consulting and service arrangements
  • Routinely waiving patient financial obligations such as copays, coinsurance, and deductibles

However, Root said, labs can take numerous steps to prevent fraud, abuse, or false claims, including implementing and maintaining an effective compliance program and training all employees on the program; training employees about potential risk areas; and performing periodic audits and monitoring.

“The present environment demands that all clinical laboratories maintain effective compliance programs,” he said.

Participating in this webinar will keep you better informed and better prepared to evaluate your lab’s billing practices and financial arrangements to ensure compliance with federal requirements.

The webinar provides 1.0 ACCENT credit. The cost to AACC members is $149; nonmembers pay $249. Online registration is simple and easy.