A recent report from HHS' Office of the Inspector General has found more than 1,000 laboratories showed unusually high billing for five or more measures of questionable billing for Medicare lab services in 2010, and Medicare allowed $1.7 billion in 2010 payments to clinical labs for questionable claims.
Nearly 50 percent of the labs that exceeded the thresholds for five or more measures of questionable billing were located in
Based on its findings, the OIG recommended stronger oversight be put into place to identify specific issues with Medicare payments for lab services. The OIG made the following recommendations to 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 Medicare billing vulnerabilities.
3. Implement measures that help ensure ineligible ordering-physician numbers are not being used and invalid claims are not being paid.
CMS agreed with all of the recommendations from the OIG.
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