How do you know their agreements don't satisfy the requirements? Have you read any of them? Not that I have, but it seems there are quite a few companies who do it. I find it hard to believe they are all breaking the law. I know some offer phlebs or processing fees.
There actually aren't "quite a few companies" paying physicians $20 per patient to collect and process specimens to them. I sell for a large reference lab and have several customers who send to HDL. One of the primary reasons they have stated to me is that they are paid $20 per patient. A single provider family practice doctor told me that he ordered it on every patient and being paid $3,000 per month just for the collection and processing. In addition to collecting the $20, the doctor also billed patients insurance for the phlebotomy fee for the other tests they collected.
The arrangement is illegal on several levels. Why do you think Quest shut down those types of arrangements when they bought Berkeley?
So what's the difference between placing phlebotomists in practices and handling fees?
In this case the potential illegality, if there is any, is between the doctor and the lab providing the P & H. The reimbursement from HDL to the office is just that, a reimbursement for services rendered. If the physician's office isn't performing the service then they should either refuse the payment or pass it through to the business that is actually doing the P&H. HDL has no way of knowing what type of arrangement the doc has with the in-practice lab. For instance, if the non-HDL lab is scheduled to pull out in a month, HDL may not know that. Likewise, if after the arrangement is made with HDL the doc decides to bring an outside lab in, how is HDL supposed to manage that? Are they required to review all contracts between the practice and other labs? Are they required to go by the office on a weekly basis to ensure that if a lab has set up shop there's a signed 'pass-through' clause in the contract.Not to worry HDL pays $20 even if they office has a Phleb from another lab drawing the specimen. So $20 to package specimens. Come on OIG wake up!!!!
