Reports

TULSA, Okla. – The U.S. Department of Labor Office of Inspector General (DOL-OIG) this month stopped payment on nearly 3,800 fraudulently filed unemployment insurance claims, including 1,300 filed from a range of IP addresses located in London, England, announced Trent Shores, U.S. Attorney for the Northern District of Oklahoma; Steven Grell, Special Agent-in-Charge, Dallas Region, U.S. Department of Labor Office of Inspector General; and Mike Hunter, Oklahoma Attorney General.

The coronavirus disease 2019 (COVID-19) pandemic has led to an unprecedented demand for diagnostic laboratory testing to determine whether an individual has the virus. Beyond the COVID-19 tests, laboratories can also perform add-on tests, for example to confirm or rule out diagnosis other than COVID-19. However, OIG has program integrity concerns related to add-on tests in conjunction with COVID-19 testing, particularly related to potentially fraudulent billing for associated respiratory pathogen panel (RPP) tests, allergy tests, or genetic tests. The Centers for Medicare & Medicaid Services has relaxed rules related to COVID-19 testing and other associated diagnostic laboratory testing to no longer require an order from the treating physician or non-physician practitioner (NPP) during the COVID-19 public health emergency. Relaxation of the physician ordering/NPP rules could allow unscrupulous actors more leeway for fraudulent billing of unnecessary add-on testing. This study will examine Medicare claims data for laboratory testing to identify trends in the use of RPP, allergy, and genetic testing and identify patterns of billing by laboratories that may indicate fraud and abuse.