The OIG found that Medicare spent an extra $901 million by not paying the lowest prices for lab tests, prices that were often found under state Medicaid or federal employee health benefits plans. Comparisons of lab test fees under other health plans to those under the Medicare Clinical Laboratory Fee Schedule revealed the discrepancy.
The OIG noted that state Medicaid and federal employee health plans incurred lower costs by accounting for changes in lab test technology and competitor information, and by sometimes requiring copayments for the tests.
The OIG suggests that the CMS work toward establishing lower lab tests payments for the fee schedule as well as consider requiring copayments and deductibles. However, the OIG noted that it is not yet clear whether CMS is authorized to revise lab test payment schedules under the current legislation.
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