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- CAP urges health officials to target anti-fraud efforts
The CAP submitted comments to the Centers for Medicare & Medicaid Services (CMS) in response to its request for information under the Comprehensive Regulations to Uncover Suspicious Healthcare (CRUSH) initiative on fraud and abuse in federal health programs.
The CAP view: We support efforts to combat health care fraud and abuse, including action against inappropriate self-referral, kickbacks, and testing without medical necessity.
- We urged CMS to clearly distinguish documented fraud from compliant laboratories operating within established clinical guidelines.
The impact: The CMS is considering policy changes that could affect coverage, payment, and administrative requirements for lab services, particularly in molecular diagnostics.
The bottom line: Broad policies risk penalizing compliant laboratories and limiting patient access without targeting the root causes of fraud.
What’s next: We will stay engaged as CMS reviews feedback and considers next steps.