decisionhealth Newsletters, Answer Books - 2009 Issue 3 (March)
ESRD / Fraud alerts / Background
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Article Overview
This article provides a high-level overview of why clinical laboratory referral relationships are scrutinized under federal fraud and abuse rules. It focuses on the role of the Office of Inspector General, the importance of fair market value in lab-related arrangements, and the types of practices that may raise Anti-Kickback Statute concerns. It is most relevant to physicians, clinical laboratories, compliance staff, and coding or billing professionals working with Medicare and Medicaid business relationships.
Why This Topic Matters
Laboratory referral arrangements can create compliance risk when compensation or other value is tied, directly or indirectly, to referrals. Understanding the general fraud-alert framework helps organizations recognize relationships that may require legal or compliance review.
What You Will Learn
- Why clinical laboratory referral relationships attract fraud and abuse scrutiny
- How the Office of Inspector General frames fair market value in health care arrangements
- What general types of lab service arrangements may raise compliance concerns
- How this background relates to Medicare and Medicaid programs
Who Should Read This
- Physicians
- Clinical laboratories
- Compliance officers
- Medical billers and coders
- Healthcare administrators
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