OUTPATIENT PAYMENTS

How to Determine Date of Service for Part B Billing of Outpatient Lab Tests

Date of service rules affect whether outpatient lab tests are part of the Hospital Outpatient Prospective Payment System (HOPPS) bundled payment or can be billed separately under Part B. Last month, … [Read more...]

ENFORCEMENT

Pain Clinic Co-Owner Pleads Guilty to Drug Testing Kickback Charges

Case: The Louisiana physician received $336,000 in kickbacks from a drug testing lab representing a percentage of the reimbursement proceeds generated via the referrals of Medicare patients' urine … [Read more...]

OIG OPINION

Is Your Billing Company Putting You At Compliance Risk?

By Sean McSweeney  bio Does your orthopedic billing company charge a percentage of collections for their coding and billing? They might break out separate charges for statements or other … [Read more...]

ENFORCEMENT

Owner of MD Practices Settles Fraud Charges for $3.07 Million

Case: Individual physicians implicated in frauds committed by the practices and clinics they own is a predominant theme in recent cases. Leading off is the MD owner of a pair of medical practices in … [Read more...]

DOJ

Enforcement Trends: New DOJ Policy Targeting Whistleblowers with Weak Cases May Make Life Easier for Labs

It's not just new laws, regulations or even court cases. Trends in health care fraud enforcement are sometimes driven by changes in prosecution policies, including those that aren't made public. Such … [Read more...]

ANTI-KICKBACK

North Carolina Hospital Settles Self-Disclosed Kickback Claims for $2.2+ Million

Case: Rex Hospital, Inc. d/b/a UNC Rex Healthcare, agreed to shell out $2,277,762 for kickbacks violations stemming from its deal to lease a doctor from a community hospital to provide cardiology … [Read more...]

COMPLIANCE PERSPECTIVES

Compliance Perspectives: CMS Reviews PAMA Reporting Basics for Hospital Outreach Labs

PAMA reporting is tricky business in which mistakes and omissions carry the risk of civil monetary penalties of up to $10,000 per day. So, whether you're with a freestanding lab that's been through … [Read more...]

COURT CASES

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

$1.99 Million Settlement for False Billing of Genetic Tests Case: In a case that began as a whistleblower suit filed by two ex-employees, GenomeDx Biosciences has agreed to shell out $1.99 … [Read more...]

CLIA

After Nearly 3 Decades, CMS Proposes Updates to Proficiency Testing Rules

When the CLIA (the Clinical Laboratory Improvement Amendments of 1988) proficiency testing (PT) regulations were first implemented in 1992, George H.W. Bush was President, gas cost about $1.05 per … [Read more...]

WHISTLEBLOWERS

Case of the Month: Facing 3 against 1, Texas Lab Settles EHR Consulting Kickback Charges

Question: What happens when multiple whistleblowers bring separate qui tam lawsuits against a lab for the same offense? Answer: Under the False Claims Act (FCA), only the first whistleblower to … [Read more...]


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