Fraud & Abuse: Federal Enforcers Fixate on Clinical Labs

Why This Topic Matters

Clinical lab billing and referral arrangements are a frequent enforcement target, and the article highlights how documentation, medical necessity, and payer claims issues can lead to substantial financial and legal exposure.

Article Sections

1. Background

   Introduces the recent federal enforcement environment affecting clinical laboratories and the general areas drawing scrutiny.

2. FMV rents

   Summarizes one enforcement matter involving physician space arrangements and related fraud and abuse concerns.

3. Cardiovascular testing

   Describes a large coordinated federal action involving laboratory-related allegations and broader testing-related schemes.

4. Medical necessity

   Focuses on allegations involving additional testing and the broader issue of documenting medical necessity for lab services.

5. Genetic testing

   Covers allegations involving genetic test solicitation, marketing arrangements, and related claim and kickback issues.

6. Reminder

   Reinforces the importance of documentation and medical necessity in laboratory billing and compliance.