decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Clinical Lab Model Compliance Plan / Essentials of OIG's Clinical Lab MCP / Prices charged to physicians
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Article Overview
This article explains a clinical laboratory compliance topic focused on how pricing practices for services billed to non-federal payers can create fraud and abuse concerns. It is relevant to compliance officers, laboratory administrators, billing professionals, and physicians who manage referral relationships. The discussion centers on why written compliance policies matter and the general federal enforcement framework implicated by these practices.
Why This Topic Matters
Laboratory pricing and referral practices can create compliance exposure if they are viewed as improper inducements tied to patient specimen referrals. Understanding the policy and enforcement context helps organizations reduce fraud and abuse risk and strengthen their compliance programs.
What You Will Learn
- Why laboratory pricing practices can raise compliance concerns
- How written compliance policies relate to laboratory pricing and referrals
- What broad federal fraud and abuse issues may be implicated by laboratory pricing practices
- Why physician referral relationships are relevant to laboratory compliance planning
Who Should Read This
- Clinical laboratory compliance officers
- Laboratory administrators
- Billing and reimbursement professionals
- Physicians and physician office managers
- Healthcare attorneys and consultants
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