When you think of most labs, you probably think about an environment in a hospital or a doctor’s office that tests for viruses and other illnesses of patients. The lab will bill the patient or the insurance company for the services that are provided. The billing tactics can sometimes lead to lab fraud. It’s not a type of fraud that is heard of very often, but it does happen. It usually takes place in either large businesses where it’s easy ton increase the costs associated with services without anyone really paying attention because there are so many services provided or in smaller businesses where there are only a few workers who see the paperwork. Unfortunately, if there is a small business involved, then most of the workers know about the fraud and don’t do anything to stop it from happening.
Lab fraud can include a variety of issues. The lab could create statements that are intentionally misleading, getting more money from insurance companies or patients, which is the easiest way to commit this kind of fraud. Another is to intentionally leave off services that have been performed. Double billing is a common procedure that is done in labs across the country, especially in areas where the company knows that there isn’t a great chance of the person making the payment for the services to find out that another bill has been made. An example would be to bill for a procedure that is done with a test and then billing separately for the same test. The insurance company would pay for both because there are two separate bills that arrive, thinking that there are two different procedures that have been done when in reality it’s the same procedure.
Most labs have to complete a form that has codes on it that is then sent to the insurance company for billing. There are some labs that will break down each code in order to get more money from the insurance company. Each service provided is billed instead of consolidating the services that are provided as they should be on the form.
One of the ways to get patients to pay more money is to bill them for lab tests that aren’t necessary. This is where doctors can sometimes come into play with lab fraud. The doctor might order a test that might not be essential in providing a diagnosis for the patient or that the patient might not need until later. The doctor might insist that the test be done to get an answer or the patient might suffer health issues if it’s not done. The patient doesn’t really know that the test doesn’t need to be done, and the lab makes money. Another common scenario is billing for tests that are never done in the first place. Most insurance companies don’t know if the patient really had a specific kind of blood work done or not. If the company doesn’t know, then it can’t really argue with paying for the service unless proof of the tests that are done is sent to the company.
Labs are not allowed to accept any kind of kickback from outside companies or doctors. They cannot take money or services in exchange for lab tests that are provided if they are completed. If you are involved in lab fraud, you need to seek the help of an attorney as you could face five to 10 years in jail, large fines and the loss of any kind of certification that you might hold while working in the lab. An attorney can sometimes work with you if you are a part of a larger group and unaware of the fraud that is taking place, getting your charges reduced or dismissed.