decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Anti-Kickback Advisory Opinion Summaries / 2005 OIG Advisory Opinions / Opinion 05-08 - Labratory Payment Plan Draws OIG's Ire
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Article Overview
This article summarizes a 2005 Office of Inspector General advisory opinion involving a laboratory’s proposed payment arrangement with physicians for blood draws and related supplies. It explains why the proposal raised fraud-and-abuse concerns, including referral risk, potential overutilization, and Medicare billing issues, and it places the opinion in the context of related OIG laboratory guidance. The piece is most relevant to compliance staff, laboratory managers, physicians, and reimbursement professionals reviewing laboratory service arrangements under federal fraud and abuse rules.
Why This Topic Matters
Laboratory payment and referral arrangements can create compliance risk when they involve physician compensation, specimen collection, or Medicare billing practices. Understanding the OIG’s concerns helps readers evaluate whether similar operational models may trigger fraud-and-abuse scrutiny or billing problems.
What You Will Learn
- The general compliance issues raised by laboratory payment arrangements with referring physicians.
- How OIG advisory opinions can affect laboratory operational and billing practices.
- Why specimen collection-related payment structures may attract fraud-and-abuse review.
- How this opinion fits within broader OIG laboratory guidance and compliance resources.
Who Should Read This
- Compliance officers
- Laboratory administrators
- Physicians
- Medical billing professionals
- Health care attorneys
- Revenue cycle teams
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