decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
Clinical Lab Services / Fraud alerts / Waiver of charges to managed care patients
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Article Overview
This premium alert explains compliance and fraud-and-abuse issues affecting clinical laboratory services when managed care plans steer testing to preferred labs and another lab considers waiving charges to keep a provider relationship. It is aimed at laboratories, physicians, compliance staff, and billing professionals who need to understand the general legal and contractual risk areas discussed in the context of federal health care program referrals.
Why This Topic Matters
Understanding these managed care billing arrangements matters because they can create fraud and abuse exposure when free services or charge write-offs are tied to patient referral patterns or utilization incentives. The article helps readers recognize the type of compliance problem involved without disclosing detailed legal analysis or implementation guidance.
What You Will Learn
- How managed care contracting can affect laboratory service arrangements
- Why waiving charges may raise fraud and abuse concerns
- What general legal framework is discussed in relation to free services and referrals
- How the article frames compliance risk for labs and physicians
Who Should Read This
- Clinical laboratories
- Physicians
- Billing professionals
- Compliance officers
- Health care administrators
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