Fraud and abuse in lab testing
linked to looser telehealth regulations.
TAMPA,
Fla., June 20, 2024 /PRNewswire/ -- Avalon
Healthcare Solutions, the world's first Lab Insights company,
applauds federal efforts to rein in fraudulent billing associated
with lab testing.
The Telehealth Modernization Act, which is passing through
Congress, includes the federal government's latest effort to
address laboratory fraud, waste, and abuse.
Specifically, it consists of a provision ordering the Office of the
Inspector General (OIG) of the U.S. Department of Health and Human
Services to submit to Congress a report by Jan. 1, 2026, assessing fraudulent Medicare and
Medicaid claims for clinical diagnostic lab tests.
"Over 14 billion lab tests are performed yearly, making it the
most commonly used medical benefit," said Avalon CEO Bill Kerr, MD. "While the overwhelming majority
of providers and labs are honest, it is important that we identify
those who abuse this crucial healthcare component to end those
abusive practices."
In the past few years, the OIG and Justice Department have
cracked down on telemedicine companies involved in fraudulent
billing schemes, some involving genetic testing. This prompted the
inclusion of anti-fraud measures in the telehealth
legislation.
Avalon prevents abuse of genetic testing through its Genetic
Test Management solutions and AvalonSelect Genetic Network, a
carefully curated group of high-quality genetic testing labs
coupled with expert consultative services. With Avalon's
comprehensive end-to-end solutions, health plans outsource the
management of genetic testing, utilization management, pricing,
compliance enforcement, test quality assessment, new lab technology
evaluation, and contracting to Avalon.
Avalon also reduces routine testing fraud, waste,
and abuse through its technology-enabled automated lab
reimbursement policy adherence and a network of labs chosen for
their high-quality and consistent results.
"We strongly encourage Congress to approve the new requirements
for preventing testing fraud. In the meantime, Avalon
will steadfastly protect payers' and members' interests by
collaborating exclusively with high-performing labs that adhere to
its stringent standards," Kerr said.
About Avalon Healthcare Solutions
Avalon Healthcare
Solutions is the world's first and only Lab Insights company,
bringing together our proven Lab Benefit Management solutions, lab
science expertise, digitized lab values, and proprietary analytics
to help healthcare insurers proactively inform appropriate care,
reduce costs, and improve clinical outcomes. Working with health
plans nationwide, the company covers over 39+ million lives and
delivers 10-20% outpatient lab benefit savings. Avalon is
pioneering a new era of value-driven care with its Lab Insights
Program that captures, digitizes, and analyzes lab results in real
time to provide actionable insights for earlier disease detection,
ensuring appropriate treatment protocols and driving down overall
costs. For more information about Avalon,
visit www.avalonhcs.com.
Media Contacts:
Michele Norton MS, RN
SVP Product Marketing, Avalon Healthcare Solutions
Michele.norton@avalonhcs.com
Janet Mordecai
Amendola Communications for Avalon Healthcare Solutions
jmordecai@acmarketingpr.com
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SOURCE Avalon Healthcare Solutions