Does EKRA apply to cash laboratory services?

jojoma14

New Member
Hello,

I work at a lab that accepts Medicare/Medicaid and cash payments. No private insurance. Am I able to pay Sales reps commission? For instance, can I give a rep 1% of non-Medicare revenue in their territory? The way our testing works is a patient needs to work through a doctor and have a doctor's authorization in order to get tested. We then charge the patient when the test is performed.

I understand that compensating for anything insurance related (Medicare, etc.) is not allowed or at best very risky legally, but I'm not sure about cash payments.

Thanks a lot for any guidance or insights.
 
I understand that compensating for anything insurance related (Medicare, etc.) is not allowed or at best very risky legally, but I'm not sure about cash payments.

You're a very savvy person.

It appears you're posting from the state that'll be hosting the Stupor Bowl on Sunday, where movies were once made, and was the original home of Mickey Mouse and Bugs Bunny.

Use your common sense, friend, don't do anything that could lead you to hot water and/or legal jeopardy.

Am I able to pay Sales reps commission? For instance, can I give a rep 1% of non-Medicare revenue in their territory?

Dismiss the thought of things that MIGHT cause a federal agent or a local LEO to come sniffing around your workplace.
 
Am I able to pay Sales reps commission?

We have no idea what abilities you have.

If that wasn't your question, what did you actually intend to ask? If the question is whether your employer has conferred on you the authority to do this, no one here will have any idea. If the question is whether it's legal, that's a question to direct to your boss and/or your employer's attorney.
 
Hello.

My lab accepts medicare but not private insurance. One of our tests costs $2600 out of pocket to non-medicare patients. Am I allowed to lower or raise the price as much as I want without causing a Medicare issue?? I think I can. Medicare has already set the reimbursement rate for that $2600 test.

Thanks a lot for any advice.
Joe
 
OK. The appropriate way to handle this is for you to speak with your supervisor or your employer's in-house legal counsel (if your employer has such a person). If there is no in-house counsel, then you (either directly or through your supervisor) should be seeking advice from an attorney retained by your employer.

You should not do or contemplate doing what you mentioned based on input from anonymous strangers on the internet.

P.S. This is basically the same response I gave to your prior post on 2/11/22.
 
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