Implications of the laboratory charges unbundling initiative

Hospitals across the United States have began to receive demand letters as part of a joint anti-fraud and abuse effort between the HHS Office of the Inspector General and the Department of Justice regarding laboratory charges unbundling. The goal of this initiative is to recover erroneous payments. U.S. attorneys have been given the opportunity to implement initiatives in their own districts. Violations may be punishable by triple damages, additional $10,000 fines for each false claim filed, and exclusion from Federally funded healthcare programs. The initiative gives hospitals the option of limiting the damages to two times the alleged billing error or single damages if they agree to participate in a self-auditing initiative. Through this initiative, hospitals agree to file an audit plan with the government and disclose the results. In order to limit damage exposure, it is important that hospitals have proof of their good-faith attempts to comply with antifraud and abuse laws by adopting compliance plans and installing software edits in their billing programs.