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Both the Illinois Senate and House Health Care Licenses Committee have passed a bill that prohibits markups of anatomic pathology services. Specifically, Senate Bill 1630 (the Bill) requires physicians, in their bills, to disclose (i) the name and address of the physician or laboratory that provided the anatomic pathology service; and (ii) the actual amount paid or to be paid for each anatomic pathology service provided to the patient by the physician or laboratory that performed the service.

The Bill also states that a physician, when billing a patient, insurer, or third-party payer, is prohibited from marking-up, or directly or indirectly increasing, the amount required to be disclosed. There is an exception which allows referring physicians to charge a specimen acquisition or processing charge if (i) the charge is limited to the actual costs incurred for the specimen collection and transportation; and (ii) the charge is separately coded or denoted as a service distinct from the performance of the anatomic pathology service.

Interestingly, the Bill also contains a private right of action which allows a patient, insurer, third-party payer, or the Illinois Department of Insurance to recover the actual amount paid if their bill violates any of these provisions.

Senate Bill 1630 is currently on the calendar for a second reading in the House. We will keep you posted on any further developments.

For more information, please contact:

Jenny McGovern
312.642.6151
jmcgovern@mcdonaldhopkins.com

Jane Pine Wood
508.385.5227
jwood@mcdonaldhopkins.com

McDonald Hopkins has a large and diverse healthcare practice, which is national in scope. The firm represents a wide variety of healthcare providers, facilities, vendors, technology companies and associations. Our diverse experience enables us to give our clients a unique perspective on the issues that may confront them in the rapidly evolving healthcare environment.

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