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Laboratory Fraud

Clinical laboratories and independent diagnostic testing facilities – referred to as IDTFs – have often been defendants in False Claims Act cases brought by whistleblowers. Common types of fraud by laboratories and IDTFs include:

  • Billing Medicare or Medicaid for medically unnecessary tests.
  • Billing Medicare or Medicaid for testing performed without the treating physician’s consent or order.  A physician may order one simple test, but the laboratory may then bill for a complex “bundle” of tests, or may bill for a complex invasive exam, rather than the physcian-order screening exam.
  • Unbundling tests normally billed as a single expense, and billing each test individually.
  • Incentivizing physicians and other medical providers to obtain Medicare and/or Medicaid business in violation of the Stark Law and Anti-Kickback Statute
  • Performing tests at an unlicensed facility, or misrepresenting where the tests were performed.
  • Billing tests that were performed by unlicensed personnel, or misrepresenting who performed the test.

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