COLA Questions UHC on BeaconLBS Accredit Rules

Why would health insurer exclude laboratories accredited by five CMS-approved organizations?

CEO SUMMARY: UnitedHealthcare’s ‘Laboratories of Choice’ network in Florida accepts only labs accredited by the College of American Pathologists and The Joint Commission. In March, COLA wrote to UnitedHealth to question this policy which excludes labs accredited by the five other accrediting bodies that hold deeming status from CMS. COLA has requested that UnitedHealthcare reconsider this program requirement, but UnitedHealthcare has not yet changed this policy.

THERE IS ONE MORE CREDIBLE CRITIC to add to the list of physicians, medical associations, and other organizations expressing their objections to UnitedHealthcare over the design and operation of its laboratory benefit management program now underway in Florida.

On March 9, COLA, Inc.’s CEO, Douglas A. Beigel, sent a letter to Catherine E. Palmier, M.D., Chief Medical Officer for UHC’s east region. In the letter, he questioned UHC’s exclusion of five CMS-deemed laboratory accrediting bodies from the laboratory benefits management program that is managed by BeaconLBS, a business division of Laboratory Corporation of America. COLA is one of the accrediting bodies that is excluded.

Only Two Accrediting Bodies

“Of special interest to me is the fact that clinical laboratories that presently receive CLIA accreditation from COLA and four other accrediting organizations are apparently excluded from participating in the program,” wrote Beigel. “Instead, in order to become a BeaconLBS ‘Laboratory of Choice,’ a laboratory can only be accredited by the two organizations specified on page two of the program’s Administrative Protocols.”

Those protocols identify the College of American Pathologists (CAP) and The Joint Commission (TJC) as the only acceptable accrediting organizations for labs that want to be in UHC’s lab of choice network. The excluded accrediting organizations are:

  • AABB
  • American Association for Laboratory Accreditation (A2LA)
  • American Osteopathic Association (accredits labs in AOA-accredited hospitals)
  • COLA
  • National Accrediting Agency for Clinical Laboratory Sciences

In the letter to UHC, Beigel stated that, “With respect to the state of Florida, COLA has an especially deep relationship. In 1995, COLA received deeming status [from the state] for the purpose of helping the state enforce its own laboratory quality law in addition to ensuring CLIA compliance. COLA presently serves 740 Florida laboratories, and has performed approximately 17,000 surveys across the state. When it comes to serving Florida laboratories, COLA has a long and proud history of success.”

Stifling Competition

Beigel further noted to UHC that, “It has long been our experience that encouraging an exclusive arrangement between a healthcare provider and selected accrediting bodies stifles fair, free, and open competition. This may have the unintended outcome of fostering a sense of complacency with respect to ensuing high quality in laboratories, perhaps compromising patient care in the process.

“Therefore, I request that UnitedHealthcare reconsider its decision to exclude five CMS-deemed accreditors from participating in its Laboratory Management Program, and instead embrace the policy of open competition established by CMS,” stated Biegel. “The resulting sense of competition among participating accreditors will result in better laboratory quality, ultimately benefiting patients.”

Unaware of Lab Accreditors

When contacted by THE DARK REPORT for comment, Beigel stated that, “We wrote the letter basically to open up a dialogue with UnitedHealthcare. Whenever an accrediting agency has been excluded in the past, we find we need to educate the insurance companies or the delivery system because usually they are unaware that CMS grants deeming authority to accrediting agencies and that the agencies can accredit to CLIA, the state requirements, and to their own standards as well.”

After UnitedHealthcare received delivery of that letter, COLA officials told THE DARK REPORT that they had been contacted by UHC staff. However, as of this date, COLA officials say that there has been no change to the status of the five lab accrediting agencies that are currently excluded from UHC’s laboratory benefit management program.

Lab Accreditors Excluded from BeaconLBS Program

HEN THE CEO OF COLA POINTED OUT that it was not unknown for a health insurer to exclude one or more medical laboratory accrediting agencies because the insurer was unaware of the existence of all seven lab accrediting bodies, that situation probably does not apply to

UnitedHealthcare in this case.

It is unlikely that UnitedHealthcare was unaware of the other organizations to which CMS has granted deeming authority for accrediting labs to CLIA. That’s because BeaconLBS is owned by LabCorp and LabCorp officials would be quite familiar with the seven lab accrediting bodies holding deeming authority. It would thus be reasonable to assume that it was the BeaconLBS officials who recommended that UHC’s laboratory of choice protocols only include labs accredited by CAP and TJC.

In fact, competing labs readily point out that, not only are five lab accrediting organizations excluded from UHC’s laboratory of choice network, but nearly all laboratories operating in Florida that also happen to compete against LabCorp are also excluded.

Lab executives from competing labs observe that it is possible these actions by UHC and BeaconLBS/LabCorp might be construed as being in violation of antitrust or anti-business laws because of how they believe that UHC’s laboratory benefit management program seems to favor LabCorp, the owner of BeaconLBS, while excluding nearly all the labs in Florida that have served patients for decades.

Contact Douglas Beigel at dbeigel@cola.org or 800-981-9883.

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