As payer audits become more frequent and complex, laboratories and healthcare providers must be equipped to respond effectively. Labs are especially vulnerable due to high-cost services and billing complexity. Triggers include but are not limited to sudden spikes in service volume, changes in test panels or clientele, use of uncommon codes or modifiers, and high
lab compliance
Staying on Top of Medical Necessity and Marketer Compliance
Below is an excerpt of an article co-authored by Government Enforcement and White-Collar Defense Team co-chair Seth Orkand, published in G2 Intelligence on March 25, 2024 .
Recent enforcement actions have made clear that fraud, waste, and abuse is a continual concern of regulating agencies for the healthcare space, including for clinical laboratories.