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OIG Publishes Study on Questionable Billing of MedicarePart B Clinical Laboratory Services

Date: July 9, 2014
Source: OIG


In 2010, Medicare payments for all (not just toxicology) Part B lab services totaled $8.2 billion. OIG conducted a study of Part B lab services to identify questionable billing patterns among Medicare lab services. This report presents its findings, which, in part, show: In 2010, over 1,000 labs exceeded the thresholds (i.e., had unusually high billing) for 5 or more measures of questionable billing for Medicare lab services. For example, a lab might have an unusually high percentage of claims with ineligible and/or in valid ordering-physician numbers, or an unusually high allowed amount per ordering
physician. Almost half of the labs that exceeded the thresholds for five or more measures of questionable billing—compared to 13 percent of all labs—were located in California and Florida, areas known to be vulnerable to Medicare fraud. Some labs that exceeded the thresholds for fewer than five measures also exhibited billing that may warrant further review. Medicare allowed $1.7 billion across all labs for claims associated with questionable billing.

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