Educate office staff to avoid fraud and abuse

June 29, 2015

In February 2015, the California Medical Association (CMA) issued a fraud alert to warn its members about clinical laboratory payments to referring physicians that may trigger fraud and abuse concerns. Some clinical labs have been offering physicians cash and gift incentives for blood draws of Medicare patients. CMA has continued to receive reports about these anti-kickback violations, which have led to several recent physician arrests in New Jersey, Virginia and other states. Furthermore, physicians' employees have also been implicated in these alleged bribes, including clerical staff and physician assistants.  

The Department of Justice forced settlements with Health Diagnostic Laboratory (Richmond, VA) and Singulex Inc. (Alameda, CA) that required payments of $47 million and $1.5 million, respectively.

Because some of these labs are based in California, it would be a good idea for CMA members to educate their office staff on the different blood-specimen collection, processing and packaging arrangements that may be prohibited under federal anti-kickback statutes. The Office of the Inspector General at the Department of Health and Human Services has released guidelines for identifying potentially fraudulent schemes.

CMA offers informational materials to help physicians understand these complex laws and the potential consequences of partnerships or agreements they enter into. Physicians with questions about specific arrangements should contact an attorney or their professional liability carrier to navigate the complexities of the anti-kickback and referral prohibitions applicable to their unique situation.

To learn more about fraud and abuse laws, see the chapter titled "Fraud and Abuse: Referral Issues" in CMA's online health law library. The health law library is free to members in CMA'sonline resource library. Nonmembers can purchase documents for $2 per page.

Contact: CMA Legal Information Line, (800) 786-4262 or legalinfo@cmadocs.org.


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