New source of lab test abuse surfaces in the form of HOPDs and MSOs

Growing numbers of hospitals are being asked to enter into a “hospital outpatient department” billing arrangement involving lab testing. One common attribute of these HOPD schemes is that the organizers want the hospital, as an in-network provider, to bill for all the lab tests performed in the organizers’ labs. The hospital and the HOPD organizers then split the payments from payers. THE DARK REPORT is first in the lab industry to recognize HOPDs as a fast-growing phenomenon that has the potential to cause unwitting hospitals and health systems to violate federal and state anti-kickback laws, Stark laws and other statutes.  In this latest generation of abuse, scammers are targeting hospitals and health systems that typically are in-network for the largest health insurers. Management companies engaged in these activities seek agreements with hospitals and health systems so that their associated physicians can refer lab tests to these facilities and then the hospitals and health systems can bill payers as in-network providers for toxicology, pain management, pharmacogenomics, molecular diagnostics, genetic, and specialty cardiology testing. The hospitals or health systems then will split the revenue with the management companies. Healthcare attorneys familiar with these arrangements say they are the newest variation on pass-through billing schemes, long-recognized as possibly fraudulent under federal and state laws.

Source: https://www.darkintelligencegroup.com/tdr-insider/lab-scheme-recruits-hospitals-to-bill-as-in-network-providers/?mqsc=E3918855&utm_source=WhatCountsEmail&utm_medium=Dark_Report_FullTDR%20Insider%20Non%20Paid%20Subscriber&utm_campaign=TDR%20Insider%20October%2030%202017