A recent article in the Wall Street Journal (WSJ) is calling attention to the topic of self-referral, an issue that has irked laboratories for years. The article, published Oct. 22, 2014, highlights a program used at 21st Century Oncology Holdings Inc.—a national chain of cancer practices—that gives its urologist a financial incentive to order fluorescence in situ hybridization (FISH) tests for bladder cancer from a central in-house lab. The Health and Human Services Office of Inspector General subpoenaed 21st Century Oncology in February requesting records, according to a company filing with the Securities and Exchange Commission (SEC). While the SEC filings didn’t mention self-referral, the WSJ article says ordering treatments and tests in-house is a pillar of the company’s business model. “By grouping several medical specialties under the same corporate roof, it captures revenues generated when one group of doctors refers patients to another,” the article states. “Its 95 urologists can get a cut of the revenues generated by the Fort Myers lab to which they refer tests.” Medicare billing records released earlier this year show that 21st Century Oncology is an outlier in billing for computer-assisted FISH testing. According to the WSJ, its two current pathologists in 2012 each…
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