NEWS AT A GLANCE

Case of the Month: Feds Turn Up the Heat on False Billing of Nuclear Stress Tests

While the feds have made urine drug testing of opioid drug patients their number one target for lab-related False Claims Act (FCA) charges this year, nuclear stress tests (NSTs) ordered by … [Read more...]

LEGISLATION

PAMA-Geddon: Lab Industry Takes CMS to Court

The nearly three-year struggle between HHS and the lab industry over PAMA has entered a new phase. On December 11, the American Clinical Laboratory Association (ACLA) filed a lawsuit asking the U.S. … [Read more...]

CYBERSECURITY

New Bill Would Make Lab Employees Criminally Liable for Concealing Data Breaches

While massive data breaches have existed as long as massive data itself, legal accountability for organizations that commit them is a relatively recent phenomenon. Breach Liability of Labs Because … [Read more...]

CLFS 2018

CMS Ignored Congressional Intent in Implementing New Clinical Lab Payment System Under PAMA, ACLA Charges in Suit

The government agency that runs the Medicare program failed to follow a congressional directive to implement a market-based laboratory payment system, thereby jeopardizing Medicare patients' access to … [Read more...]

COMPLIANCE CORNER

Medicare Exclusions: One Week, Two Different Labs Get the Boot

Exclusion of a clinical lab from participating in Medicare or other government health programs is a relatively rare penalty. But last month, there were two of them reported in the span of less than a … [Read more...]

PAMA

CMS Ignores Flawed Processes, Finalizes 2018 PAMA Pricing; Labs Need to Take Immediate Action to Offset Impending Lean Times

By Kyle Fetter  bio The final 2018 clinical laboratory fee schedule (CLFS) is out, and it is evident that the argument that the Centers for Medicare & Medicaid Services (CMS) PAMA … [Read more...]

NEWS AT A GLANCE

Case of the Month: Lab Tests Play Key Role in $19 Million Detroit Opioid Scheme

A physician just pleaded guilty to ordering millions in medically unnecessary lab tests? So what else is new? Please pass the butter… Granted, stories like the Oct. 12 guilty plea of that physician … [Read more...]

FALSE CLAIMS

Case of the Month: FMC Settlement Is Poster Child for False Billing of Lab Tests

In the grand scheme of things, $2 million is fairly small potatoes for false billing of lab tests—especially considering that it allegedly went on for 10 years. Even so, if you're running your lab's … [Read more...]

FALSE CLAIMS

That CAN’T Be Right: Court Says Labs Must Independently Verify Medical Necessity of M.D. Ordered Tests

Based on the enforcement track record, if your lab ever gets charged with falsely billing Medicare for lab tests, failure to document the medical necessity of the ordered tests will be the reason. … [Read more...]

PAMA

Draft 2018 CLFS Reveals Fundamental Flaws in PAMA Reporting Exercise; Time to Take Action

By Lâle White  bio As XIFIN predicted, the PAMA reporting exercise has resulted in significant proposed laboratory fee cuts. In fact, the multi-year decrease for the top 20 laboratory tests … [Read more...]


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