I am just glad I going into academics so that I don't have to worry about this stuff, but still it pisses me off.
Academics do have to worry about it though. I know of a few academic centers (some are small, granted, and maybe pseudoacademic) who lost a great deal of their biopsy revenue because the clinicians have all the leverage. The hospital needs their inpatient business and outpatient surgeries so they allow them to operate as independent contractors, and then of course they do their biopsies outside and send them elsewhere. Some hospitals and groups are respectable enough and big enough to thwart this at least someone, but most will suffer to some extent.
But yeah, I can't really figure out how any respectable medical organization can sit by while a group of physicians bill for someone else's work. I don't really think it's as simple as there being too many pathologists. I'm sure that's part of it. But there are also simply a lot of large labs who are always willing to take more specimens in and collect the technical component, and these labs facilitate this sort of thing.
It should be medicare fraud, but the rules are written with so many loopholes and vaguaries that it never matters. And government really doesn't care if some physicians are profiting more at the expense of other physicians - they only care if they are getting defrauded.