January 20, 2025

The Case for comprehensive Medical Review Officer (MRO) oversight: Your shield against legal risks and ensuring integrity

By Guest Contributer

By National MRO

Within the drug testing industry, Medical Review Officers (MROs) play a critical role in interpreting laboratory results and ensure drug testing programs are scientifically valid and legally defensible. For regulated testing, the U.S. Department of Transportation (DOT) mandates MRO oversight for all test results—not just non-negative outcomes. However, many non-regulated programs cut corners by excluding MRO reviews for negative results, a practice fraught with risks. This article explores why entrusting all laboratory results to an MRO is vital, particularly for third-party administrators (TPAs), organizations and employers seeking to avoid liability and uphold ethical standards.

DOT regulations have established clear precedent for comprehensive MRO oversight of drug test results. According to 49 CFR Part 40, MROs are mandated to review all laboratory-reported drug test results, including negatives. This oversight ensures the integrity of the process is upheld, and that even seemingly straightforward negative results are scrutinized for compliance with procedural and scientific standards.

This regulatory standard exists for good reason. Laboratory errors, clerical mistakes and chain-of-custody issues can happen even with negative results. By adhering to a comprehensive review process, regulated employers benefit from an additional layer of legal and procedural protection, which non-regulated employers would be wise to emulate.

When a donor consents to testing and signs a non-regulated Custody and Control Form (CCF), the donor is implicitly trusting that their sample will be handled with the same level of care and scrutiny as any other type of drug test. If an MRO’s name is printed on that form, it creates a reasonable expectation of the donor that an MRO will review the results. Diverting the medical review process to save costs (based on laboratory result’s outcome) can be perceived as a breach of trust—or worse, as non-consensual or fraudulent behavior. Transparency in the chain of custody and result verification is not just a regulatory expectation, but a critical ethical standard that should apply to all drug testing – regulated or not because that was what was proposed and consented to by the donor.

For further clarity, organizations and employers who pay for MRO services generally do so with the understanding that the MRO will review all test results—not just the non-negatives. If an organization or employer decides to exclude negatives from MRO review, they should explicitly address this deviation in their contractual agreements (both with the MRO and those that are being tested) and adopt alternative forms that make the custody and testing process clear. Without doing so, they again weaken the defensibility of their drug testing program or policy and invite challenges and claims that may be more difficult to defend because their processes have deviated from established industry standards. Additionally, these alternatives often lack the rigor and defensibility of the MRO-reviewed processes, and by failing to engage the MRO comprehensively, organizations and employers risk compromising the perceived reliability of their testing program. Worse, they could be accused of cutting corners at the expense of employee rights and workplace safety for the sake of the program’s cost, which is an almost impossible position to defend.

While bypassing MRO review for negative results may seem cost-effective initially, the long-term risks far outweigh the short-term savings. Consider the potential costs of litigation, reputational damage, or labor law violation-related fines arising from a flawed testing program. Comprehensive MRO oversight, on the other hand, ensures every result—positive or negative—is subjected to expert evaluation and review. This proactive approach not only minimizes risk but also strengthens the organization’s or employer’s position in disputes, audits, or legal proceedings.

Bypassing MRO review for negative results introduces a significant legal vulnerability into a drug testing program. A program that bypasses established safeguards can be challenged as procedurally flawed or even negligent. Imagine a scenario where a negative test result is later called into question during litigation or legal scrutiny of a number of tests. When asked whether the MRO had reviewed all of the test results entered into evidence, the court may be surprised to hear that some of the tests were never reviewed by the MRO or their directly supervised staff. Without MRO review, the organization or employer is left defending a process that lacks a cornerstone of scientific and procedural validation, not to mention opening the door of impropriety for a potential claimant to easily walk through. Or more significantly, an opportunity for past employees, who were subjected to disciplinary action as a result of an outcome of a now deemed-to-be-flawed program, to make claims as well.

Without the MRO’s review, there is no guarantee the result truly reflects proper testing protocol. Those who create “fake” MRO reports for negative results—some even using the MRO’s name and signature on reports without the actual review work being completed or directly supervised by an MRO—risk accusations of fraud. Such practices may be found to be not only unethical but could lead to severe legal consequences for all parties involved. Not to mention the unintended impact this may have on the organization’s, employer’s or TPA’s insurability. For example, their insurance policies may rely on an understanding, of the insurance policy’s underwriter, that the testing program adheres to industry known, standard practices. If either party willingly diverts the reasonably expected process, that the insurer expects to be completed as part of an industry-compliant program, the insured could find themselves without coverage in a liability or errors-and-omissions-related claim.

If MRO review of negative results were truly unnecessary, why is it that most non-regulated workplace drug testing Chain of Custody Forms (CCF) include a section for the MRO? Despite unsubstantiated claims that MRO oversight and review is not required for negatives, no widely accepted CCF excludes the MRO’s involvement entirely by omitting the MRO section. Further, most laboratories strongly recommend that all non-regulated negative results be sent to an MRO for review in an effort to ensure specimen and procedural integrity and legal defensibility. This industrywide standard begs the question: If the MRO’s role is dispensable for negatives, why do the forms and laboratory procedures recommend their inclusion? Specifically on Copy 2 of most non-regulated CCFs, which provides the pre-printed option for the MRO to deem the test result as negative and sign the document attesting to the outcome of the test. The answer lies in the need for consistency, accountability, and the assurance that every test result, whether positive or negative, has been managed according to the highest standards. Purposefully removing the MRO from the equation undermines these objectives and introduces unnecessary risks into the testing program.

Lastly, as more states enact laws legalizing cannabis for medical or recreational use, the landscape of workplace drug testing has become increasingly complex. Organizations, employers and TPAs must navigate these evolving legal frameworks carefully because processing a drug test result incorrectly could result in significant legal challenges, especially when an adverse employment action is involved. The variability in state laws introduces the risk of conflicting interpretations and requirements, making it crucial to rely on a legally defensible testing system. By adopting a testing protocol that mirrors regulated standards, including comprehensive MRO oversight, employers and TPAs can ensure every step of the process adheres to established, proven, and now somewhat everchanging guidelines. This approach not only mitigates the risk of lawsuits and lessens unnecessary scrutiny, but also provides a robust framework for defending employment decisions based on drug test results. In a climate where drug testing protocols are under increasing scrutiny, having a consistent and credible system in place is the best defense against legal uncertainty and potential liabilities.

Those managing drug testing programs are responsible for ensuring drug testing practices are fair, transparent, and legally sound. By excluding MROs from negative result reviews, programs may inadvertently erode employee, or donor, trust and violate the principles of informed consent. This is particularly important in a non-regulated context, where the absence of stringent federal oversight makes the role of the MRO even more critical in maintaining procedural integrity.

The merits of having an MRO review all laboratory test results—regulated or non-regulated—are clear. Comprehensive MRO oversight protects organizations, employers and TPAs from liability while reinforcing the credibility of the testing process. Organizations and employers who forgo this step risk compromising their programs’ legal defensibility and ethical standing. Simply put, by investing in full-spectrum MRO services, organizations and employers demonstrate their commitment to fairness, accuracy, and accountability in their drug testing program and position their programs beyond reproach.

At National MRO, we believe every test result deserves expert attention. Contact us today to ensure your drug testing program meets the highest standards of compliance, integrity, and legal defensibility.

And remember: drug testing isn’t just a process—it’s a responsibility.