Health Law Alert: CMS Ranks Labs as "Moderate" Risk


Ober|Kaler's Health Law attorneys are regular contributors to Medical Laboratory Observer's "Liability and the Lab" column at This article appears in the May 2011 edition.

Q: Can you explain some of the new Medicare and Medicaid regulations established to prevent fraud?

A: Effective March 25, 2011, the Centers for Medicare and Medicaid Services (CMS) implemented new regulations designed to enhance enrollment procedures to protect against fraud — required by provisions in the 2010 healthcare-reform legislation. One of the key components of these new regulations is the separation of providers and suppliers into three categories (“limited,” “moderate,” or “high” risk), with more rigorous screening procedures as the perceived risk increases. Independent clinical laboratories have been identified as “moderate” risk, although a provider’s or supplier’s risk category may change over time as warranted by CMS’ risk assessment.

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DISCLAIMER: Because of the generality of this update, the information provided herein may not be applicable in all situations and should not be acted upon without specific legal advice based on particular situations.

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