OIG Targets COVID-19 Test Labs for Potential Add-on Testing Abuses

Are labs taking advantage of the unprecedented demand for COVID-19 testing to bill Medicare for high reimbursing and medically unnecessary add-on tests? That’s what the OIG suspects and it plans to conduct an investigation to confirm its suspicions.

The Potential for COVID-19 Add-on Testing Abuse

The objective of COVID-19 testing is to determine whether an individual has the virus. However, as the OIG points out in its latest work plan addition, labs can also perform add-on tests, e.g., to confirm or rule a diagnosis other than COVID-19. In the new work plan item expresses, the agency says it has “program integrity concerns” related to add-on tests in conjunction with COVID-19, particularly the potential of fraudulent billing for associated respiratory pathogen panel (RPP) tests, allergy tests or genetic tests.

Adding to the concern is the fact that during the public health emergency CMS has relaxed the rules requiring an order from the treating physician or nonphysician practitioner (NPP) for COVID-19 tests. And, according to the OIG, relaxation of physician ordering/NPP rules gives “unscrupulous actors more leeway for fraudulent billing of unnecessary add-on testing.”

The OIG Game Plan

To address these concerns, the OIG plans to perform a study analyzing Medicare claims data for lab testing to identify trends in the use of RPP, allergy and genetic testing and identify billing patterns indicating that labs may be committing fraud and abuse.

Takeaway

If your lab is performing add-on tests in conjunction with COVID-19 testing, be sure that you have clear and complete records documenting that those tests are medically necessary for the particular patient.