An advisory opinion released last week by the U.S. Department of Health and Human Services Office of Inspector General (OIG) advises labs not to enter exclusive agreements with physician practices that would cover patient fees for certain insurance plans. This type of agreement could violate anti-kickback laws and lead to an investigation and possibly administrative sanctions.
The OIG responded to a request from a “multi-regional medical laboratory that provides clinical laboratory, anatomic pathology, and forensic pathology services” that owns 45 patient service centers in multiple states. According to the laboratory, physician practices expressed a desire to work with a single laboratory; however, certain exclusive insurance plans require patients to use a specific laboratory for testing. The laboratory agreed to waive the fees for those patients, allowing physicians to use a single laboratory for all of their tests.