New Report Details Medicare Abuse

Wednesday, 09 Jul 2014 03:07 PM

By Melanie Batley

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Medicare paid $1.7 billion in 2010 to clinical laboratories in claims that have since been identified as questionable, a new report has found, highlighting concerns about the healthcare program's vulnerability to abuse.

According to a report by the Department of Health and Human Services' Office of Inspector General, more than 1,000 laboratories showed five or more categories of questionable billing during that year, The Wall Street Journal reported.

The charges in many cases related to routine tests such as blood counts, cholesterol screenings, metabolic panels, and hormone tests, and the report identified that many of the billing practices were questionable, costly, and should be investigated further.

The services lend themselves in part to suspect billing because doctors order the services separately instead of providing them directly, according to Medicare fraud specialists.

"Wherever you've got a set of multiple parties involved in the care of a given patient, you've got an opportunity for the dishonest to make something of it," Bill Mahon, president of Mahon Consulting Group in Great Falls, Va., which helps healthcare payers reduce their exposure to fraud, told the Journal.

Medicare is the nation's largest payer of clinical laboratory services, paying a total of $8.2 billion in 2010 for lab services, the Journal reported. Spending for lab services increased by 29 percent between 2005 and 2010.

Forty-three percent of the labs that had five or more questionable billing measures were located in California and Florida, states known for high rates of Medicare fraud, according to the Journal.

Aaron Albright, a spokesman for CMS, told the Journal that the agency "will continue to utilize all available tools to identify and prevent improper billing practices."


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