CMS

Lab Fails in Bid to Get Medicare Payment Suspension Set Aside

Case: In 2017, CMS suspended 100% of Medicare payments to True Health Diagnostics (THD) based on what it called “credible allegations of fraud.” Two years later, while the suspension was still in … [Read more...]

FALSE CLAIMS

Federal Court Dismisses Urine Drug Test False Billing Claim

Case: Whistleblowers accused a national lab company of falsely billing Medicare and Medicaid for high complexity quantitative urine drug tests under CPT code G0431 at up to $476 per test. According to … [Read more...]

ENFORCEMENT

Enforcement Trends: New Takedown Is Evidence that Genetic Testing Has Become an Enforcement Priority

It’s a pretty good sign that fraudulent billing of genetic lab testing has become a priority for federal fraud enforcers when it gets its very own “takedown.” Known as Operation Double Helix, the … [Read more...]

OIG

Work Plan: OIG Targets Medicare Part B Urine Drug Testing

Falsely billing Medicare Part B for urine drug testing has loomed large on the OIG’s radar even before the opioid crackdown began. Last February, for example, the OIG issued a report claiming that CMS … [Read more...]

The New CMS Medicare Exclusion Rules & How to Comply with

On Nov. 4, 2019, a new Final Rule, aka the Program Integrity Enhancements to the Provider Enrollment Process, broadens CMS’ powers to kick labs and other providers and suppliers out of Medicare and … [Read more...]

Labs In Court

A roundup of recent cases and enforcement actions involving the diagnostics industry ACLA Goes for Knockout Punch in PAMA Lawsuit  Case: Having survived a first-round setback, the American … [Read more...]

Compliance Perspectives: California Case Illustrates Lab’s Liability Risks for “Causing” MDs to Submit False Claims

False Claims Act (FCA), 101: Knowingly submitting a false claim to Medicare or another federally funded health care program is a violation. But what’s lesser known is that your lab can also be liable … [Read more...]

MARKETING

LabCorp Must Go to Trial to Defend against Deceptive Trade Practices Charges

Case: Fourteen patients sued LabCorp for allegedly overcharging them for lab tests. In March 2018, a North Carolina federal court tossed their class action ruling that the patients didn’t have a valid … [Read more...]

Anti-Kickback

Special Report: Long Awaited Kickback Relief Rules Keep Labs in the Cold

They’re finally here! After years of talking about adapting the decades-old kickback laws to modern medical market conditions, CMS and OIG proposed new rules (the Proposal) on Oct. 9, 2019. Whether it … [Read more...]

Current Issue of LCA

  Before You Download Please read the following user agreement and confirm your acceptance of the terms before you download LCA content: I agree that I am the the only person who is … [Read more...]


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