In OIG Advisory Opinion No. 13-03, the Office of Inspector General had the opportunity to deal with two issues which have always raised concerns in the past, i.e. pod labs and swapping. It is no surprise that OIG refused to issue a favorable advisory opinion regarding these issues, and one suspects the request was submitted just to clarify the uncertainty regarding the issues.
The facts in 13-03 are as follows:
1. A lab management company will establish and lease separate laboratory suites to physician practices.
2. The physician practices will use these laboratory facilities for all non-federal healthcare program business.
3. The physician practices will refer all federal healthcare program business to independent laboratories; the physician practices may, but will not be required to, refer those services to the company that is providing the lab management services.
The conclusion states that the OIG has a long standing concern about arrangements under which the parties "carve out" referrals for federal healthcare program beneficiaries or business. The proposed arrangement allows the physician group the opportunity to expand into the “potentially lucrative opportunity to expand into the clinical laboratory business with little or no business risk.” OIG concludes there is a likelihood the physicians will order services from the current laboratory for federal healthcare program beneficiaries.
