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Phlebotomists and Equipment in Client Offices

According to the Department of Health and Human Services (HHS):
"When permitted by State law, a laboratory may make available to a physician's office a phlebotomist who collects specimens from patients for testing by the outside laboratory. While the mere placement of a laboratory employee in the physician's office would not necessarily serve as an inducement prohibited by the anti-kickback statute, the statute is implicated when the phlebotomist performs additional tasks that are normally the responsibility of the physician's office staff. These tasks can include taking vital signs or other nursing functions, testing for the physician's office laboratory, or performing clerical services. Where the phlebotomist performs clerical or medical functions not directly related to the collection or processing of laboratory specimens, a strong inference arises that he or she is providing a benefit in return for the physician's referrals to the laboratory. In such a case, the physician, the phlebotomist, and the laboratory may have exposure under the anti-kickback statute. This analysis applies equally to the placement of phlebotomists in other health care settings, including nursing homes, clinics and hospitals. Furthermore, the mere existence of a contract between the laboratory and the health care provider that prohibits the phlebotomist from performing services unrelated to specimen collection does not eliminate the OIG's concern, where the phlebotomist is not closely monitored by his [or her] employer or where the contractual prohibition is not rigorously enforced."
HHS considers the provision of computers or fax machines to a client office by the laboratory to be an inducement, "unless such equipment is integral to, and exclusively used for, performance of the outside laboratory's work."
To summarize:
Laboratories may place phlebotomists or other employees in a physician office if all of the following are done:
  • Employee only performs laboratory-related tasks.
  • There is a written understanding given to the physician about what the employee can and cannot do.
  • Periodic audits are done to ensure the employee is following these policies.
Laboratories may place printers, computers, fax machines or other equipment or products in client offices as long as the laboratory ensures that:
  • The physician understands the equipment belongs to the laboratory.
  • It is used for laboratory purposes like receiving reports or ordering tests.
  • Periodic audits are done to ensure that the client is using the equipment only for laboratory-related activities.

Reference: Department of Health and Human Services. Publication of OIG special fraud alerts; December 19, 1994. Sections, Provision of Phlebotomy Services to Physicians; Other inducements. Available at: https://www.oig.hhs.gov/fraud/docs/alertsandbulletins/121994.html. Accessed August 20, 2018.