REIMBURSEMENT

PAMA: OIG Backing of CMS Heats Up Market-Based Lab Rates Controversy

CMS did it right and saved Medicare a boatload of money in the process, concludes a new OIG report reviewing the methods CMS used to establish "market-based" rates for Medicare Part B lab tests. Of … [Read more...]

BILLING AND COLLECTIONS

Shareholders Sue Missouri Hospitals for Alleged Lab Billing Ripoff

Case: A new shareholder lawsuit targets the CEO and other individuals at a Missouri 10-hospital group called HMC Hospitals for allegedly running a $90 million lab billing fraud scheme out of the … [Read more...]

PAMA

Proposed 2019 Medicare PFS: The 5 Things Labs Need to Know

On July 12, CMS issued the proposed 2019 Medicare physician fee schedule (PFS), with comments scheduled to end on Sept. 10. Takeaways: 1. Physician Payment Rates¬† CMS is proposing a 0.25% increase … [Read more...]

WHISTLEBLOWERS

Kickback Settlement Costs Pennsylvania Hospital $13.1 Million

Case:¬†The most expensive kickback settlement of 2018 to date features Post Acute Medical, LLC (PAM) in the starring role. The case which began as a whistleblower lawsuit, claims the Pennsylvania-based … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: August 2018

Of the 12 new Work Plan items, four have direct implications for labs and billing of lab tests. 1. Medicare Payments for Clinical Diagnostic Laboratory Tests in 2017: Year 4 of Baseline Data Issue: … [Read more...]

LAB SAFETY

The Safety Interpretation

By Dan Scungio, MT (ASCP), SLS, CQA (ASQ)  bio When hospitals were placed on OSHA's list of "high-risk" workplaces, no one had to ask why. OSHA adjusts that list based on the number of … [Read more...]

ENFORCEMENT

Whistleblower Sues Montana Health System Officials for Elaborate Kickback Scheme

Case: The CFO of a Montana hospital physician network filed a qui tam lawsuit against his employer for paying physicians above-market compensation in exchange for referrals to network labs, … [Read more...]

ANTI-KICKBACK

Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry

Kickback Settlement Costs Pennsylvania Hospital $13.1 Million Case: The most expensive kickback settlement of 2018 to date features Post Acute Medical, LLC (PAM) in the starring role. The case … [Read more...]

PAMA

Proposed 2019 Medicare HOPPS Rule: The 4 Things Labs Need to Know

Heads up to labs that bill Medicare for services to hospital outpatients: CMS issued the proposed 2019 hospital Outpatient Prospective Payment System (OPPS) on July 25, with comments scheduled to end … [Read more...]

CYBERSECURITY

TOOL: Model Employee Social Networking Policy

The purpose of this policy is to outline acceptable and unacceptable use of any computer equipment and other technology by all "employees" (as defined below) of XYZ Laboratories ("XYZ") as such use … [Read more...]


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