The Inspector General must report on lab test fraud risk by January 1, 2028
What the document says“Not later than January 1, 2028, the Inspector General of the Department of Health and Human Services shall submit to”
Subsection (b) of section 6212 requires the Inspector General of the Department of Health and Human Services to submit to Congress, by January 1, 2028, a report assessing fraud risks for clinical diagnostic laboratory tests payable under section 1834A of the Social Security Act and effective tools for reducing fraudulent claims. The report may, at the Inspector General's discretion, identify high risk tests, set out amounts payable and volumes, note whether orders came from providers without a prior relationship with the patient, count how often code 59 or 91 was used, and suggest strategies including outlier monitoring and targeted education.
What the document actually says“Not later than January 1, 2028, the Inspector General of the Department of Health and Human Services shall submit to”
There is a watchdog office inside the health department. By January 1, 2028 it must send in a report.
The report is about lab tests that carry a high risk of false claims. It goes to Congress. Much of what it holds is left to the watchdog.
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