By: Julie M. Eggington, Ph.D., Ekaterina Cleary, Ph.D. and Leeza Osipenko, Ph.D.
The recent request for information from the Centers for Medicare and Medicaid Services signals the Trump administration is serious about rooting out healthcare fraud.
The request places particular emphasis on genetic and molecular pathology testing. But the most damaging abuse of lab testing may be of a kind that CMS typically overlooks. Across the nation, doctors and patients are making treatment decisions based on laboratory testing that has never been proven to work. In many cases, clinical laboratories aren’t even following professionally recognized standards of healthcare.
The more moderate estimate is that roughly half of the laboratory developed tests most commonly used in hospitals and laboratories in the US, suffer from design flaws, inadequate validation, and process problems that may…
This type of fraud targets the supply chain and accounts payable departments of businesses.
- Invoice Manipulation: Criminals intercept a legitimate invoice between a supplier and a client and change the banking details to their own. The client pays the bill thinking they are paying their trusted vendor.
- Kickbacks and Bribery: A vendor secretly pays an employee of the purchasing company to ensure their bid is successful or to overlook inflated pricing.