AHA says no legal basis for lab billing probe
There is no legal basis for the federal government's probe of outpatient laboratory billing practices for Medicare patients, according to a report prepared for the American Hospital Association. The U.S. Department of Justice has sent letters to many hospitals throughout the country implying that the hospitals are guilty of fraud because they didn't bundle several tests for a single payment. But the AHA commissioned a law firm to investigate the matter, and the AHA says the firm's report shows that "there was never a legal or regulatory requirement" that hospitals bundle the tests.
AHA president Dick Davidson says the Justice Department's investigation is like "getting a very expensive ticket for going through a green light." The charges actually can be traced to mistakes by the government that resulted in overpayments, plus inconsistent guidance given to hospitals.
As proof that the bundling was never required, the report cites a manual for fiscal intermediaries provided by the Health Care Financing Adminis tration, in which HCFA says there is no obligation to bundle tests. Additionally, many of the fiscal intermediaries had advised hospitals that if they did not bundle the tests themselves, the intermediaries would do it for them.
Davidson says the report shows that the Justice Department has "willingly and knowingly pursued prosecution of hospitals based on no laws, no regulations, and conflicting government instructions to hospitals. Clearly, this is nothing more than a collection effort."
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