As DOJ and CMS intensify healthcare fraud enforcement, labs face rising scrutiny over billing and documentation. This Clinsights post explores how physician office labs can use AI tools like Elara to predict compliance risks, check claims against CMS frequency rules, and align with insurer expectations—turning data integrity into a true competitive advantage.

A new bipartisan bill—the Reforming and Enhancing Sustainable Updates to Laboratory Testing Services (RESULTS) Act—aims to freeze Medicare Clinical Lab Fee Schedule (CLFS) rates through 2028 and reshape how future rates are set. Labs have been bracing for up to 15% Medicare cuts across ~800 tests starting in 2026. Without intervention, independent labs, hospital outreach labs, and POLs would also be required to report 2019 private-payer data by March 2026—a costly and burdens

Welcome to the September edition of Clinsights Monthly, where we spotlight the latest policy shifts, quality challenges, and diagnostic trends shaping the lab industry.