Case: A trio of individuals associated with a Miami substance abuse facility were charged with taking part in a scheme to bill private insurers for tests that weren’t medically necessary or, in some … [Read more...]
LABS IN COURT
Urgent Care Centers Settle E/M Upcoding Charges for $2 Million
November 28, 2019
Case: The owners/operators of CareWell urgent care centers in Massachusetts and Rhode Island have agreed to shell out $2 million for improper coding of Evaluation and Management services. CPT code … [Read more...]
COMPLIANCE PLANS
OIG Work Plan: Agency to Focus on Collection of Medicare Advantage Ordering Provider Identifiers
November 28, 2019
OIG needs ordering provider identifiers in the Medicare Advantage (MA) encounter data to be available so it can use the data to identify and prevent potential fraud, waste and abuse. However, although … [Read more...]
Labs In Court
November 28, 2019
A roundup of recent cases and enforcement actions involving the diagnostics industry Lab’s ‘False Positive’ Drug Test Report ≠ Defamation of Employee Case: An Arkansas nurse got fired … [Read more...]
HIPAA Compliance: Quest Pays $195K to Settle Class Action for HIV Data Breach
November 28, 2019
Government fines, public embarrassment, loss of provider and patient trust. As if these consequences weren’t scary enough, massive PHI breaches can expose your lab to a new kind of risk: class action … [Read more...]
Compliance Corner: Must Employee Notify Lab of DUI?
November 28, 2019
QUESTION If one of our employees gets a DUI, do they have to notify us? ANSWER It depends. EXPLANATION There are at least four factors affecting whether the employee would have to come … [Read more...]
Marketing Pitfalls to Avoid: Deceptive Advertising—the Other Kind of “False Claims”
November 28, 2019
We all know that marketing activity is a breeding ground for potential lab liability. But while most labs are sensitive to the risks posed by the Antikickback Statute, Stark Law and False Claims Act, … [Read more...]
ENFORCEMENT
Quest Pays $88.7K to Settle Specimen Collection Fee Kickback Charges Against Its Subsidiary
November 20, 2019
Case: After self-disclosing, Quest has settled kickback claims against its wholly-owned subsidiary, Quest Diagnostics TB LLC, for $88,780. The OIG alleges that from June 2011 to December 2016, the lab … [Read more...]
FDA WATCH
FDA Watch: Agency Resounds the Alarm on Biotin Test Interference
November 19, 2019
In early November 2019, the U.S. Food and Drug Administration (FDA) updated a previous safety communication about the potential of biotin to significantly interfere with diagnostic tests. The … [Read more...]
TESTING TRENDS
Testing Trends: The Debate Continues Over Regular Colorectal Screening for Average Risk Adults
November 16, 2019
Should adults age 50 to 75 who are at average risk and show no symptoms of colorectal cancer have regular colorectal screening exams? Last month, a major medical journal came out against regular … [Read more...]
