Under Pressure
Robert Mills, a spokesman for the physician`s group, has said: ``There used to be pressure, [on physicians to use LabCorp] but the protocol changed after the AMA sent a letter. United Healthcare agreed that if a physician refers a patient out of network [for lab tests], the physician wouldn`t be penalized``.
In contrast to the state-run Medicaid programs where, by law facilities that cooperate with the program must offer the lowest price available, Medicare is required to pay the standard and customary charges. This could potentially be an obstruction to support a successful False Claims Act filed on the behalf of Medicare, because the agency has yet to define establish guidelines to determine what an unreasonable charge would be.
Andrew Baker says that in the absence of a federal law guaranteeing Medicare the same low prices as Medicaid he will have to rely on proving anti-kickback statutes to solidify his case. Baker has also stated that ``The kickbacks are not obvious, I need to prove United Healthcare and LabCorp are in cahoots``.