OIG Fraud Alert Highlights Specimen Collection, Registry Payment Risks

July 16, 2014 | Strategic Insights for Health System


​Although the U.S. Department of Health and Human Services' Office of Inspector General (OIG) has frequently warned of fraud and abuse risks associated with payments from laboratories to physicians who could be sources of referrals, the agency continues to see two potentially troublesome trends in this area, it notes in a June 25, 2014, Special Fraud Alert. OIG notes that it has repeatedly emphasized that providing free or below-market goods or services to a physician who is a source of referrals, or paying a physician more than fair market value for his or her services, could constitute illegal remuneration under the antikickback statute. In the alert, OIG first discusses blood specimen collection, processing, and packaging arrangements, under which labs pay physicians either directly or indirectly to perform these services. This practice has several implications under the antikickback statute, particularly if the labs reimburse more than fair market value or if the reimbursement is for services that are also billed to federal healthcare programs.

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