Lab organizations react to Office of Inspector General report on clinical labs' billing practices

July 14, 2014

Questionable Billing for Medicare Part B Clinical Laboratory Services, the report released by the Office of Inspector General last week, drew sharp responses from at least two leading lab organizations. The OIG reviewed 94,609 labs and found that 1,032 had “exceeded the thresholds for at least five of 13 measures of questionable billing.” The National Independent Laboratory Association (NILA) and American Clinical Laboratory Association (ACLA) have released statements criticizing OIG for creating a misleading impression in its report.

According to NILA, the report “creates an impression that Medicare allowed $1.7 billion in 2010 payments to clinical laboratories that were inappropriate or fraudulent. However, the OIG did not verify the accuracy of the data it used, and did not conduct medical record reviews to validate information; and none of the measures it analyzed confirm that a particular laboratory is engaging in fraudulent or abusive practices.” Says Mark Birenbaum, PhD, administrator of NILA: “Bad actors must be identified and excluded from the program, but it is inappropriate and misleading to use unverified data to paint a picture that abuse is widespread.”

ACLA has similar concerns. “It is critical that providers of clinical services across the healthcare sector remain committed to appropriate utilization and prevent fraudulent or abusive billing practices,” says Alan Mertz, President of the ACLA. “That said, the methodology used in the OIG report on questionable billing practices must be further examined to ensure a clear picture is presented and accurate conclusions are reached.” Mertz notes the report’s own admission that some of its 13 “metrics” could represent completely legitimate and clinically appropriate utilization of clinical laboratory services, a fact that must be considered in the report’s final analysis of potential “questionable” billing practices before jumping to conclusions about actual fraud. Download the OIG report.

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