If a doctor sends a patient's biopsy to a pathology lab that offers him a discounted rate, then is reimbursed for the testing at a higher rate by the patient's insurer — reaping a profit in the process — he may be within the law, but the practice has engendered debate. These are typically wink-wink deals between doctor and lab, with patients and insurers unaware that an outside lab did the work at a discount and that the doctor simply marked up the price without adding any value. Doctors say they're entitled to mark up work farmed out to a contractor to cover costs such as billing for the work and delivering the results to patients. "It doesn't cost $40 for a GI practice to do the billing and collection," says one fed-up pathologist glumly. "It's called fee-splitting — taking a service that someone else provided and cutting a deal to profit as a middleman. Splitting the fees. For a referral. I would say that's unprofessional."