2012 brings new challenges for those medical professionals involved in CLIA certified clinical laboratory testing. Khouri Law Firm has seen an increase in medical necessity issues arising from the frequency of testing of drug rehabilitation patients. Medicare, Medicaid, and private insurance companies often disagree with the prescribing doctors as to the number of times a patient should be tested. In addition to recommending the preferred codes in the 80100 or G0431 series, our firm advises and defends laboratories, billing managers, and doctors facing Stark violations charges for physician-owned laboratories.
Medicare and Medicaid are also investigating laboratories for overcharging these two programs relative to other insurance companies who are being provided the same service. Federal Law states that Medicaid patients should be charged the lowest possible price for laboratory testing. In 2011, the government penalized major laboratory testing companies for charging less for cash patients or HMO’s. The penalties and back billings can run into the millions of dollars. The same issues exist with Medicare. However, Medicare does not specifically state “lowest possible price” but “usual and customary price”.
Khouri Law has defended lab testing around the country and been working in the healthcare field for 30 years. If you believe that your billings are under investigation by Medicare, Medicaid or recovery audit contractors, please give us a call before any further contact with auditors or investigators. You have rights and we will protect those rights.