Most of the state laws only protect AP from client billing schemes. Before the law was enacted in my state, the going rate for skins was less than 10 bucks. Paps were around 18 bucks. Client billing has always seemed like a kickback to me. Some of the stuff we have to do to get business walks a fine line between legal and illegal. I am just glad I have never been to prison. I don't think I would do well in a Kentucky prison.
It is still the wild west with CP. I have noticed less CP client billing in my area due to physician office's being part of health systems now. Our health system ended the practice a year or two ago on CP.
It is hard to blame the government for passing PAMA when you see labs doing work for virtually below cost just to have the medicare work.