Outpatient Facility Coding Alert - 2014 Issue 24
Compliance: OIG: We're Looking at You, Laboratories
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Article Overview
This compliance article reviews a recent OIG Special Fraud Alert involving laboratory payments to referring physicians and explains why laboratory-physician financial relationships are drawing heightened scrutiny. It is relevant to laboratories, physician practices, compliance staff, and revenue cycle professionals who need a high-level understanding of federal anti-kickback and physician self-referral concerns. The piece also references CMS guidance on the physician referral law and describes the general kinds of arrangements that may raise compliance risk.
Why This Topic Matters
Laboratory and physician practice relationships can create significant fraud-and-abuse exposure if financial arrangements are not structured appropriately. Understanding the scope of OIG and CMS oversight helps organizations recognize compliance risk areas and review their referral relationships more carefully.
What You Will Learn
- Why laboratory payments to referring physicians attract federal scrutiny
- How OIG describes fraud-and-abuse risk in lab-to-physician arrangements
- What the article says generally about the physician self-referral framework
- Which types of laboratory-practice relationships are discussed as compliance concerns
- Where to find the referenced OIG and CMS guidance resources
Who Should Read This
- Laboratories
- Physician practices
- Compliance officers
- Healthcare administrators
- Revenue cycle professionals
- Medical billing staff
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