We wonder why there are billing concerns and prior authorization requirements with insurance companies for genetic or genomic testing that patients truly deserve and, when appropriate, changes outcomes substantially in patient care?
Why would these organizations put up these “barriers” so that patients don’t have “access”?
Well….the bad apples make really bad decisions that cost us all MILLIONS+ of dollars. This particular lab owner went to jail and owes more than $370 million back for Medicare Fraud.
“In August 2022, the United States filed a complaint-in-intervention against Rajen Shah and his companies United Diagnostics Lab, Tomoka Medical Lab, Tennessee Valley Regional Laboratory, Luminus Diagnostics, and Golden Rule Management for violations of the False Claims Act. The complaint alleged that Shah caused his laboratories to bill Medicare for “expensive” molecular tests that were not ordered by a licensed healthcare provider.”
“The integrity of our healthcare system depends on the government being able to rely on accurate and truthful information submitted by laboratories, and that labs only bill for services ordered by a beneficiary’s doctor or nurse practitioner,” said U.S. Attorney Handberg. “We will continue to hold people accountable when they disregard Medicare’s regulations.”
When labs start doing the right thing with billing, as well as ensuring accurate results, maybe insurance companies will decrease the ‘perceived barriers’. Otherwise, our entire healthcare reimbursement system will continue to scrutinize this testing and could possibly collapse.
The full article can be read here: https://www.justice.gov/usao-mdfl/pr/united-states-obtains-more-370-million-judgments-against-kentucky-businessman-and-his