Knowledge base

Clinical Laboratory Fraud

Clinical laboratory reimbursement is delineated by a list of CPT/HCPCS Codes. The code billed must correlate to the lab test(s) conducted. Clinical laboratory services are literally defined as the biological, microbiological, serological, chemical, immunohematological, hematological, biophysical, cytological, pathological, or other examination of materials derived from the human body for the purpose of providing information for the diagnosis, prevention, or treatment of any disease or impairment of, or the assessment of the health of, human beings, including procedures to determine, measure, or otherwise describe the presence or absence of various substances or organisms in the body. Violations of the False Claims Act in the laboratory setting include but are not limited to billing for tests on expired medium, billing for compromised specimens, billing for identical tests on multiple specimens, and billing for tests neither supported by a diagnosis nor ordered by a physician, and billing for tests ordered as a result of kickbacks.

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