PAMA Reimbursement: CMS Tells Labs How to Secure ADLT Status for New Tests

Although the 2018 market-based Clinical Laboratory Fee Schedule (CLFS) is officially in effect, implementation of the new PAMA Part B payment rules for lab tests remains a work in progress. On March … [Read more...]


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

Lab Accused of Inflating Specimen Travel Mileage Pays $525K to Settle Case: The feds accused a Missouri lab of submitting false claims to Medicare for travel fees in transporting specimens from … [Read more...]


Getting Paid: Medicare to Cover Next Gen-Sequencing Tests for Advanced Cancer

In the PAMA era, there are two salient trends in Medicare Part B lab reimbursements: Sharply lower prices for traditional tests; and Wider coverage of newly emerging tests, including some that … [Read more...]


OIG Work Plan Monthly Review: April 2018

Four of the six new items that the OIG added to its workplan have an impact—albeit indirect—on labs: 1. CMS Recovery of Medicare Overpayments Issue: Between Oct. 1, 2014 and Dec. 31, 2016, OIG … [Read more...]


Compliance Perspectives: New Stark Rules Offer Some Physician Kickback Relief but Not Nearly Enough

As a lab compliance officer, you have better things to do with your time than read government budget bills. But what you do need to know is that the new federal Bipartisan Budget Act of 2018 includes … [Read more...]


Brief Your CEO: New Penalties Double the Dollar Value of Protecting Your Lab from Liability

You may not realize this, but Congress has just doubled the dollar value of what you do as a compliance manager to keep your lab out of federal health care fraud hot water. How? By significantly … [Read more...]


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

No Dice for Whistleblower Claim Blaming Software Firm for Double-Billing Case: A physician coding supervisor for a North Carolina health system that used billing software from Epic filed a qui tam … [Read more...]


Diagnostic danger in the lab: Time to reform how we process orders

By Oleg Bess, M.D.  bio I don't know about you, but I was stunned by the findings from a recent report published by Coverys, a national liability insurer, which I feel should put the entire … [Read more...]


CMS to OIG: Get Back the $66.3 Million You Improperly Paid to Labs for Urine Validity Tests

As if times were not already tense enough for labs that bill Medicare for urine drug tests, the OIG ratcheted up the pressure another notch on Feb. 20 by issuing a new report chiding CMS for making … [Read more...]


You Make the Call: Do Cost-Savings Payments to Referring Physician Violate Kickback Laws?

SITUATION XYZ Consultants recommends that a hospital client cut costs by making 34 changes to its OR spinal fusion surgeries procedures. The recommendations fall into two broad categories, including … [Read more...]