Centers for Disease Control Should Discontinue Certain Diagnostic Tests and Charge for Others

HRD-83-37: Published: Apr 6, 1983. Publicly Released: Apr 11, 1983.

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In response to a congressional request, GAO reported on the Centers for Disease Control (CDC) laboratory diagnostic testing services program.

A diagnostic analysis of sample specimen records showed that, although the CDC diagnostic testing service is supposed to be a final resort for testing specimens, 46 percent of the diagnostic specimens tested at CDC during fiscal year (FY) 1981 were not tested initially by commercial or state laboratories. GAO estimated the cost of unnecessary testing by CDC at $1.9 million. Further, GAO found that specimens were not screened to determine whether prior testing had been performed. CDC laboratory personnel contended that it was easier to perform the tests than to screen and reject requests. Federal regulations require CDC to recover the full cost of diagnostic testing services that it provides to private health care providers, clinical laboratories, and other federal agencies. However, in FY 1981, CDC collected no fees from private health care providers or clinical laboratories and only about $30,000 from other federal agencies. GAO estimated that CDC could have collected about $3.3 million in user charges from private health care providers and $662,000 from other federal agencies.

Recommendations for Executive Action

  1. Status: Closed - Not Implemented

    Comments: Since the issuance of the report, CDC has, on two separate occasions, requested in its congressional budget submissions that it be granted approval to collect user fees for diagnostic testing services. Congress has not granted CDC the authority to collect such fees. No further requests by CDC are anticipated.

    Recommendation: The Secretary of Health and Human Services should require the Director, CDC, to recover the total cost of laboratory diagnostic testing services provided to private beneficiaries and other federal agencies and to determine the extent to which other nonfederal agencies should be charged. More specifically, CDC should be directed to: (1) charge private health care providers and private clinical laboratories for diagnostic testing; (2) determine the extent to which other nonfederal recipients of CDC testing services should be charged by applying the provisions of the user charge statute and Office of Management and Budget Circular A-25; and (3) charge all federal agencies for diagnostic testing.

    Agency Affected: Department of Health and Human Services

  2. Status: Closed - Not Implemented

    Comments: In the 4 years since the issuance of the report, CDC has taken no actions which can be directly attributable to this recommendation. Although GAO believes this recommendation is still appropriate, the lack of congressional support on this matter makes further followup questionable.

    Recommendation: The Secretary of Health and Human Services should require the Director, CDC, to improve and enforce diagnostic specimen screening procedures. CDC should be directed to prepare, and maintain on a continuing basis, a list of diagnostic tests which it and commercial or state laboratories can perform. Such a list would be used at the state and CDC laboratory levels to identify those specimens which should be tested initially at a commercial or state laboratory rather than CDC. In addition, CDC should not accept specimens for testing that are not accompanied by all available information requested on the forms provided by CDC for use in submitting specimens. Finally, CDC should not accept specimens for testing which are submitted directly from private health care providers and clinical laboratories unless such submissions are authorized by both CDC and the state laboratory.

    Agency Affected: Department of Health and Human Services

 

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