Diagnostic Testing in Medicare Requirements and Prohibitions
Diagnostic testing in Medicare is a thorny, complicated subject that touches on multiple different regulatory schemes, requirements, and prohibitions. Many physicians and their managers are confused by the interplay of Stark, anti-kickback, incident-to, and supervision rules. If not managed effectively, this issue can lead to overpayments, denied claims, and false claims liability. Dan explores these issues in two articles. In “Stark, Diagnostic Testing, and Group Compensation,” Dan examines how diagnostic testing can affect a physician group’s compliance with Stark, especially with regards to how the group pays its physicians. In “Navigating Spaghetti Junction: The Intersection of Medicare’s Diagnostic Testing Rules,” Dan takes a much deeper dive into the topic and explores a broader range of Medicare regulations and how they intersect in diagnostic testing. The article offers both legal analysis, and touches on real-world experiences our clients have had in this area.