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- Federal anti-fraud effort will look at lab services
The Centers for Medicare & Medicaid Services (CMS) anti-fraud and waste initiative, called "CRUSH," is asking the public for tips on how to find savings and eliminate fraud in federal health programs like Medicare and Medicaid.
The impact: The request for more information from the public mentions laboratory testing, including genetic and molecular diagnostic tests.
- Genetic tests made up 5% of Part B lab tests in 2024 but drove 43% of spending—$3.6 billion.
- For pathologists and labs, CMS’ focus could affect future coverage, payment, and documentation expectations for high-cost molecular and genetic tests.
The bottom line: CMS is making laboratory fraud a priority and wants stakeholders to address program integrity concerns, including MolDX program challenges.
The Medicare agency is signaling a strong push to curb unnecessary spending.
Next steps:
- The CAP will be responding with its own comments by the March 30 deadline.
- Consider coordinating with your practice or institution on whether, and how, you’ll provide input as well.
- Review the full request for information and submit feedback by the deadline.