IBC has become aware that potentially misleading information about member
cost-sharing (e.g., copayment, coinsurance, deductible) is being distributed on
documents that display the Quest Diagnostics name and logo. The information
indicates that members can continue using Quest Diagnostics after July 1
without additional member financial impact or cost-sharing. Please be
assured that Quest Diagnostics will be an out-of-network provider effective
July 1, 2014.
Waiving member cost-sharing has long been prohibited under the federal
anti-kickback laws when used in connection with federally funded programs, such
as Medicaid and Medicare, which may now include Qualified Health Plans on the
Federally Facilitated Marketplace. In addition, routine waiver of cost-sharing
may be a violation of the Federal False Claims Act, subject to investigation by
the Office of Inspector General and/or any applicable state insurance
department?s fraud division.
Use an in-network laboratory provider
Your Professional Provider Agreement with IBC requires you to direct members
and/or their lab specimens to a participating laboratory, except in an
Emergency, as otherwise described in the applicable Benefit Program
Requirements, or as otherwise required by law. The ordering physician shall
obtain preapproval before referring a member to a non-participating
provider.
If you have any questions about this information, please email us.