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July 31, 2015

Federal Auditors Question Lab Fees

The HHS inspector general has released a report on Medicare Part B spending for clinical laboratory services. HHS auditors examined lab payments from 2005-10, and despite a 10 percent increase in Medicare enrollment, lab payments increased by 29 percent.

The report’s recommendations to the Centers for Medicare and Medicaid Services:

There may be some labs that have legitimate reasons for exceeding certain thresholds. However, collectively, these findings call for stronger oversight of labs and identify specific issues with Medicare payments for lab services that need to be addressed to more effectively safeguard Medicare. Therefore, we recommend that CMS (1) review the labs identified as having questionable billing and take appropriate action, (2) review existing program integrity strategies to determine whether these strategies are effectively identifying program vulnerabilities associated with lab services, and (3) ensure that existing edits prevent claims with invalid and ineligible ordering-physician numbers from being paid.

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