The OIG provided the following arrangements that are likely to trigger Anti-Kickback Statute enforcement.
1. A laboratory makes payment to a physician for services for which payment is also being made by a third party such as Medicare.
2. A laboratory makes payment directly to an ordering physician rather than to the ordering physician’s group practice, which may bear the cost of collecting and processing the specimen.
3. A laboratory makes payment to a physician on a per-specimen basis for more than one specimen collected during a single patient encounter or on a per-test, per-patient or other basis that takes into account the volume or value of referrals.
4. A laboratory offers payment to a physician on the condition that the physician order a specified volume or type of tests or test panel, especially if the panel includes duplicate tests or tests that are otherwise not medically necessary.
5. A laboratory makes payment to a physician or the physician’s group practice, even though the specimen processing is actually being performed by a phlebotomist placed in the physician’s office by the laboratory.
6. A laboratory makes payment to a physician that exceeds fair market value for services actually rendered.
More Articles on the Anti-Kickback Statute:
8 Recent Anti-Kickback Lawsuits
5 Things to Know About Co-Management Agreements
5 Recent FCA Employee Whistle-Blower Case Settlements
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