ENFORCEMENT

Compliance Perspectives: Feds Using Medicare Laws to Prosecute Non-Medicare Arrangements

Myth: Risk of federal prosecution for health fraud and abuse applies only when you deal with Medicare, TRICARE or other federal health programs. Truth: While that used to be true, the times they are … [Read more...]

COMPLIANCE GUIDANCE

Brief Your CEO: Explain How New DOJ Guidance Can Get Your Lab Out of FCA Hot Water

New guidance from the DOJ lays out sheds light on a crucial matter that many high-ranking lab executives are forced to confront: whether to "play ball" with the federal government when internal … [Read more...]

WHISTLEBLOWERS

Case of the Month: U.S. Supreme Court Gives Whistleblowers Four More Years to Sue

Just as the tide seemed to be turning against whistleblower lawsuits (see "New DOJ Policy Targeting Whistleblowers with Weak Cases May Make Life Easier for Labs," (Lab Compliance Advisor,  March 4, … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: May 2019

Of the three new items in this month's OIG Work Plan items, one may have implications for some labs. Access to Medication-Assisted Treatment at Health Centers Issue: Medication-assisted … [Read more...]

NEWS

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

West Virginia Medicaid Recovers $17 Million for $8.5 Million Opioid Scam Case: A subsidiary of Acadia Healthcare Co. has agreed to pay $17 million to settle charges of falsely billing West … [Read more...]

COMPLIANCE CORNER

HIPAA Compliance: The Pitfalls of PHI De-Identification & How to Avoid Them

In 2016, the Australian government released medical billing records of 2.9 million people. They tried to protect patient privacy by removing names and other identifying data. But it didn't work. … [Read more...]

CODING

Tennessee Pain Doctor Faces Jail for Opioid Abuses, Medicare Fraud

Case: The doctor is facing 45 charges, including 22 counts of illegal distribution of a controlled substance for routinely prescribing oxycodone and other Schedule II drugs without examining and … [Read more...]

FALSE CLAIMS

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

WV Hospital & Marketing Consultant Sued for Elaborate Kickback Scheme Case: A new DOJ lawsuit accuses a West Virginia non-profit hospital and its business consultant of seeking to dominate the … [Read more...]

ANTI-KICKBACK

Pain Management Clinic, 2 MDs Pay $99K to Settle Millennium Free POCT Cup Kickback Claims

Case: An Oklahoma pain management practice and two of its physicians are the latest to settle kickback claims for accepting free point of care test cups from now defunct Millennium Laboratories. The … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: April 2019

Among the 10 new Work Plan items this month, three may have potential ramifications for at least some labs. Medicaid Managed Care Organization Denials Issue: The State Medicaid agency and the … [Read more...]


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