Avalon Healthcare Solutions Welcomes Federal Measures to Combat Lab Fraud

Fraud and Abuse in Lab Testing Linked to Looser Telehealth Regulations

TAMPA, Fla., June 20, 2024Avalon Healthcare Solutions, the world’s first Lab Insights company, applauds federal efforts to rein in fraudulent billing associated with lab testing.

The Telehealth Modernization Act, which is passing through Congress, includes the federal government’s latest effort to address laboratory fraud, waste, and abuse. Specifically, it consists of a provision ordering the Office of the Inspector General (OIG) of the U.S. Department of Health and Human Services to submit to Congress a report by Jan. 1, 2026, assessing fraudulent Medicare and Medicaid claims for clinical diagnostic lab tests.

“Over 14 billion lab tests are performed yearly, making it the most commonly used medical benefit,” said Avalon CEO Bill Kerr, MD. “While the overwhelming majority of providers and labs are honest, it is important that we identify those who abuse this crucial healthcare component to end those abusive practices.”

In the past few years, the OIG and Justice Department have cracked down on telemedicine companies involved in fraudulent billing schemes, some involving genetic testing. This prompted the inclusion of anti-fraud measures in the telehealth legislation.

Avalon prevents abuse of genetic testing through its Genetic Test Management solutions and AvalonSelect Genetic Network, a carefully curated group of high-quality genetic testing labs coupled with expert consultative services. With Avalon’s comprehensive end-to-end solutions, health plans outsource the management of genetic testing, utilization management, pricing, compliance enforcement, test quality assessment, new lab technology evaluation, and contracting to Avalon.

Avalon also reduces routine testing fraud, waste, and abuse through its technology-enabled automated lab reimbursement policy adherence and a network of labs chosen for their high-quality and consistent results.

“We strongly encourage Congress to approve the new requirements for preventing testing fraud. In the meantime, Avalon will steadfastly protect payers’ and members’ interests by collaborating exclusively with high-performing labs that adhere to its stringent standards,” Kerr said.

About Avalon Healthcare Solutions
Avalon Healthcare Solutions is the world’s first and only Lab Insights company, bringing together our proven Lab Benefit Management solutions, lab science expertise, digitized lab values, and proprietary analytics to help healthcare insurers proactively inform appropriate care, reduce costs, and improve clinical outcomes. Working with health plans nationwide, the company covers over 39+ million lives and delivers 10-20% outpatient lab benefit savings. Avalon is pioneering a new era of value-driven care with its Lab Insights Program that captures, digitizes, and analyzes lab results in real time to provide actionable insights for earlier disease detection, ensuring appropriate treatment protocols and driving down overall costs. For more information about Avalon, visit www.avalonhcs.com.

Media Contacts:
Michele Norton MS, RN
SVP Product Marketing, Avalon Healthcare Solutions

Janet Mordecai
Amendola Communications for Avalon Healthcare Solutions

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