Why OIG Did This Review. Medicare Part B spending on COVID-19 lab tests increased steadily between spring 2020- when Medicare first started paying for these tests-and the end of that year. Preliminary analysis of Medicare Part B claims data indicated that some diagnostic testing laboratories billed for other diagnostic tests-such as individual respiratory tests (IRTs), respiratory pathogen panels (RPPs), genetic tests, and allergy tests-along with COVID-19 tests. We refer to these four types of tests billed with COVID-19 tests as add-on tests. Although it is not unusual for labs to bill for COVID-19 tests and other diagnostic tests on the same claim, certain billing patterns-such as a high volume of or high payments for add-on tests-raise concerns of potential waste or fraud. How OIG Did This Review. We performed outlier analysis to identify labs that billed for add-on tests at questionably high levels compared to other labs that billed for COVID-19 tests. We identified two kinds of outlier labs: (1) those for which add-on tests constituted a high proportion of each lab’s total number of tests, and (2) those for which add-on tests constituted a high proportion of each lab’s total payments for tests. We examined all Medicare Part B claims paid for COVID-19 tests during 2020, and for the following types of add-on tests: IRTs, RPPs, genetic tests, and allergy tests.
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