Medicare Exclusions: One Week, Two Different Labs Get the Boot

Exclusion of a clinical lab from participating in Medicare or other government health programs is a relatively rare penalty. But last month, there were two of them reported in the span of less than a week.

The Prohealth Exclusion
On Oct. 24, an independent lab in Southern California called Prohealth Neurodiagnostic, Inc. and its owner agreed to a five-year exclusion. The allegation: Prohealth allegedly billed for nerve conduction studies that the medical necessity provisions of its Local Coverage Determination listed as screening exams and thus not covered by Medicare.

The Total Lab Care Exclusion
Five days earlier, Total Lab Care, LLC accepted permanent exclusion from all federal health programs. The allegation: The Jacksonville, Florida lab billed for testing urine toxicology samples referred by a physician to whom it paid improper financial remuneration.


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