OIG Releases 2016 Work Plan; Report on Lab Payments Expected

The OIG released its 2016 Work Plan that continues to name laboratories as a source of concern with regard to Medicare billing and payment. The OIG’s annual Work Plan provides a summary of new and continuing reviews that the agency is undertaking to protect the integrity of, and find opportunities to improve the efficiency of, U.S. Health and Human Services programs. This year’s Work Plan continues an item introduced in last year’s Work Plan: “Selected independent clinical laboratory billing requirements.” The agency is concerned about Medicare payments to independent clinical laboratories—specifically, it’s looking for labs that “routinely submit improper claims.” The OIG claims that audits and investigations indicate independent clinical laboratories are at risk for noncompliant Medicare billing. Once again, the OIG also promises to review Medicare payments for clinical diagnostic laboratory tests, including the top 25 clinical diagnostic laboratory tests by Medicare expenditures. This item was added in the OIG’s mid-year update to the 2015 Work Plan and is required by the Protecting Access to Medicare Act. The OIG says it has found in the past that Medicare “pays more than other insurers for certain high-volume and high-expenditure laboratory tests. The newest item relevant to laboratories indicates the OIG is focusing on the propriety of payments to histocompatibility laboratories, which reported $131 million in reimbursable costs on recent cost reports (covering March 31, 2013 through Sept. 30, 2014).


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