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Audits of Medicare Part B Laboratory Services During the COVID-19 Pandemic

Laboratory tests are critically important because they are used for early detection, diagnosis, monitoring, and treatment of disease. COVID-19, the disease caused by a new strain of coronavirus that had not been previously identified in humans, first emerged in China in December 2019, and the first reported U.S. case occurred in January 2020. Because of the rapid worldwide spread of the virus, the World Health Organization declared COVID-19 a global pandemic in March 2020. To protect the health and safety of the American people and to assist the Department of Health and Human Services and its Federal partners, laboratories began to provide COVID-19 testing to identify individuals who had contracted the coronavirus that causes COVID-19. Laboratory testing for both COVID-19 tests and non-COVID-19 tests (i.e., laboratory tests that are not for COVID-19) is important for all Medicare beneficiaries, but may be especially important for beneficiaries with certain medical conditions who are identified to be at increased risk for severe illness from COVID-19. Ensuring individuals receive necessary laboratory tests is critical to improving health care quality and containing long-term health costs.

Our preliminary analysis has shown that the number of non-COVID-19 tests billed for Medicare Part B beneficiaries during the COVID-19 pandemic has decreased compared with the 6-month period before the pandemic, and many independent laboratories have encountered challenges in providing COVID-19 testing. We will conduct a series of audits on Medicare Part B laboratory services during the pandemic that will initially focus on the effect of the pandemic on non-COVID-19 testing. The series of audits will also focus on aberrant billing of COVID-19 testing during the pandemic.

Announced or Revised Agency Title Component Report Number(s) Expected Issue Date (FY)
Completed (partial) Centers for Medicare and Medicaid Services Audits of Medicare Part B Laboratory Services During the COVID-19 Pandemic Office of Audit Services W-00-21-35867;