The U.S. Department of Health and Human Services Office of the Inspector General (OIG) is conducting an audit of laboratory services for Medicare Part B recipients during the COVID-19 pandemic. Preliminary analyses have shown that compared with the six-month period immediately preceding the pandemic, billing for non-COVID-19 laboratory testing experienced a sharp decrease during the pandemic and certain laboratories experienced difficulty sustaining reliable COVID-19 testing.
The OIG is also conducting a trend analysis of Medicare laboratory billing for COVID-19 add-on testing. The OIG expressed concerns with program integrity related to add-on tests in conjunction with COVID-19 tests. In particular, the agency is investigating potentially fraudulent billing for associated respiratory pathogen panel (RPP), allergy, and genetic testing. Due to the pandemic, the Centers for Medicare & Medicaid Services is not requiring an order from a treating physician or nonphysician practitioner (NPP) for COVID-19 testing and other associated diagnostic laboratory testing. The OIG says relaxation of physician ordering/NPP rules could allow more leeway for fraudulent billing of unnecessary add-on testing. The OIG study will focus on Medicare claims data for laboratory testing to identify trends in use of RPP, allergy, and genetic testing and determine billing patterns that may indicate fraud and abuse.
The audits will consider a variety of areas, including whether COVID-19 and non-COVID-19 tests are eligible for Medicare reimbursement; whether billing for specimen collection and travel is warranted; whether COVID-19 testing was bundled with unnecessary tests; and whether proper coding was employed in billing.
Sources: https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000565.asp
https://oig.hhs.gov/reports-and-publications/workplan/summary/wp-summary-0000489.asp
