Looking upon Medicare billing and payment of lab services with suspicion is and has always been part of the OIG’s organizational DNA. So, the fact that audits of Medicare Part B lab services during the pandemic are among the new items the OIG added to its Work Plan in February should come as no surprise. But this item comes with a twist to the extent that the OIG’s primary concern seems to be not overbilling but whether labs have actually been billing enough for Part B tests since the pandemic began. OIG Oversight of COVID-19 Testing This isn’t the first time that the OIG has incorporated review of COVID-19 testing into its Work Plan. Last July, the agency announced plans to look into potential abuses of add-on tests, e.g., to confirm or rule a diagnosis other than COVID-19. In the Work Plan item, the OIG agency said it had “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, the OIG explained, was the decision of CMS to temporarily relax the rules requiring an order from the […]
Looking upon Medicare billing and payment of lab services with suspicion is and has always been part of the OIG’s organizational DNA. So, the fact that audits of Medicare Part B lab services during the pandemic are among the new items the OIG added to its Work Plan in February should come as no surprise. But this item comes with a twist to the extent that the OIG’s primary concern seems to be not overbilling but whether labs have actually been billing enough for Part B tests since the pandemic began.
OIG Oversight of COVID-19 Testing
This isn’t the first time that the OIG has incorporated review of COVID-19 testing into its Work Plan. Last July, the agency announced plans to look into potential abuses of add-on tests, e.g., to confirm or rule a diagnosis other than COVID-19. In the Work Plan item, the OIG agency said it had “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, the OIG explained, was the decision of CMS to temporarily relax the rules requiring an order from the treating physician or nonphysician practitioner (NPP) for COVID-19 tests during the public health emergency. Relaxation of physician ordering/NPP rules gives “unscrupulous actors more leeway for fraudulent billing of unnecessary add-on testing,” the OIG warned. As of February, the agency has yet to release its report on the add-on testing audit.
The New OIG Initiative
However, the OIG audit item in the February 2021 Work Plan is a bit different from previous initiatives. The agency’s normal inclination is to question whether commonly billed lab tests are really necessary; but this time, the OIG is wondering why more tests are not being performed—specifically, tests for conditions other than COVID-19. The “number of non-COVID-19 tests billed for Medicare Part B beneficiaries during the COVID-19 pandemic has decreased compared to the six-month period before the pandemic,” the OIG notes. The agency also expresses a seldom seen sympathy for labs by acknowledging that “many independent labs have encountered challenges in providing COVID-19 testing.”
As a result, the OIG says it will audit utilization of Medicare Part B lab services during the pandemic focusing initially on non-COVID-19 testing. Of course, the Work Plan item adds, the agency will also look into “aberrant billing of COVID-19 testing during the pandemic.”
Takeaway
It was only a matter of time before the OIG took a good hard look into lab testing during the pandemic. But this latest audit initiative is different in tone and scope. While rooting out the bad apples is always will be the objective—including with regard to the still pending July Work Plan item targeting add-on tests for COVID-19 test subjects—this time it sounds like the OIG’s primary motivation is genuine concern for and eagerness to assist testing labs in their efforts to survive pandemic struggles.
