FREE WEBINAR
Lab Results Are In:
2025 Enforcement and Payer Dispute Trends and
Regulatory Developments
Aired on December 3, 2025 at 1pm EST
60 Minutes with Live Q&A
Stay ahead of mounting regulatory and reimbursement pressures—join this essential webinar to uncover 2025’s key enforcement trends and equip your laboratory with actionable strategies for compliance and financial resilience in 2026.
60-Minute Webinar Sponsored By
The past year has been pivotal for laboratories. Commercial payers continue tightening coverage policies, increasing pre-payment edits, and enforcing medical-necessity documentation, creating operational and financial pressure on both independent and hospital-based laboratories.
Enforcement activity from the OIG, DOJ, and CMS continues to intensify, with laboratory audits increasingly focused on test frequency, genetic and molecular billing, and the use of modifiers 59 and 91.
This session will provide a comprehensive review of the year’s most significant enforcement and payer dispute trends reimbursement and regulatory developments impacting the laboratory industry. Attendees will gain a clear understanding of what happened in 2025, what current enforcement trends are, and what actions laboratories should take now to safeguard compliance, maintain reimbursement integrity, and strategically prepare for 2026.
Join us for, "Lab Results Are In: 2025 Enforcement and Payer Dispute Trends and Regulatory Developments," which aired on December 3, 2025 at 1:00 PM EST to gain the insights and strategies your lab needs to stay compliant and financially resilient in 2026.
Key Learning Objectives:
- Identify recent trends in payer disputes involving clinical laboratories, including common denial rationales such as lack of medical necessity, improper ordering/referral relationships, or alleged pass-through billing.
- Identify key federal and state enforcement actions from the past year involving clinical laboratories, including DOJ, OIG, CMS, and private payer initiatives.
- Analyze common themes in recent enforcement activity—such as medical necessity, referral relationships, and billing practices—and understand how these trends may signal future areas of scrutiny.
- Develop proactive strategies to maintain revenue integrity and mitigate compliance risk in 2026 and beyond.
Expert Panel
Caitlin Forsyth
Partner
Davis Wright Tremaine LLP
Caitlin Forsyth, Partner, Davis Wright Tremaine LLP, has more than ten years of experience working with clinical, toxicology, and genetic laboratories, as well as pathology practices. Her extensive background enables her to effectively connect with clients, providing in-depth advisory services tailored to their specific needs. Her expertise includes advising on CLIA and state lab licensing requirements, ensuring laboratories comply with both federal and state regulatory standards. She also addresses state law considerations related to billing requirements, ensuring laboratories adhere to proper procedures and compliance requirements. She assists clients in responding to requests for information from Medicaid Fraud Control Units, as well as subpoenas and civil investigative demands from federal and state enforcement authorities. Additionally, she supports clients facing medical record audits and overpayment demands from private payers, helping them resolve billing and compliance challenges efficiently.
Darla Wanitschke
Vice President, Customer Success
TELCOR
Darla Wanitschke, Vice President, Customer Success, joined TELCOR in January 2010. She has held several roles at TELCOR including sales, implementation, and special projects. Her keen insights and strategic approach have revolutionized revenue cycle efficiencies for a diverse range of labs. Darla has also served as a director of revenue cycle management for two molecular diagnostic labs, showcasing her versatility and depth of expertise within the laboratory space. Before venturing into the lab industry, Darla dedicated over 25 years to the financial services sector, honing her skills and developing a wealth of experience she translates into her role at TELCOR.
Who should attend?
- Laboratory Directors
- Laboratory Administrators
- Laboratory leaders responsible for market access, finance, billing, and revenue cycle management
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