PAMA

Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 2019

The battle between CMS and the lab industry over Medicare Part B pricing for lab tests could be on the road to resolution notwithstanding the ACLA's recent court loss. But even as the legal battle … [Read more...]

ENFORCEMENT

Provider Fined for Not Taking Compliance Measures Required by Its CIA

Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]

LEGISLATION

New Broad All-Payor Kickback Law Impacting Laboratories, Commission-based Compensation and more

By Danielle Sloane bio and Chris Climo bio In a recent piece of federal legislation intended to address the opioid crisis across the United States, Congress enacted a new all-payor kickback … [Read more...]

BILLING AND COLLECTIONS

Texas Lab and Owner Get 15-Year Exclusion for Medicare Mileage Swindle

Case: What would you do if your bill for a $43 blood test included a $1,500 travel fee? The patient who actually received such a bill from Texas lab BestCare complained to the government. The … [Read more...]

LEGISLATION

Compliance Alert: New Private-Pay Opioid Law Puts All Drug Addiction & Rehab Labs at Risk of Federal Prosecution

Recent federal legislation addressing the opioid crisis may have unintended consequences on the lab industry. The idea was to allow the feds to prosecute a certain kind of abuse banned by the … [Read more...]

FALSE CLAIMS

Florida Lab Owners Convicted for Role in Notorious Drug Distribution Scheme

Case: The two brothers who own a Palm Beach lab pleaded guilty to health care fraud for their role in the illegal drug distribution conspiracy carried out by notorious sober home operator Kenny … [Read more...]

HEALTH CARE REFORM

Case of the Month: Texas Court Strikes Down Obamacare—So, Now What?!

What came as a Christmas gift to many Republicans could be a lump of coal in the stockings of health insurers and the patients they cover. On Dec. 14, a federal judge in Texas did the unthinkable by … [Read more...]

ENFORCEMENT

By the Numbers: DOJ Recovers Billions in FY 2018

Year after year, the False Claims Act (FCA) remains the federal government's most valuable fraud enforcement tool. Although recovery amounts have declined slightly in the past two years, FCA … [Read more...]

CONSUMER FRAUD

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

Molecular Lab Vigorously Denies But Pays $1.8 Million to Settle Fraud Charges Case: The feds claim that Molecular Testing Labs, a toxicology and genetics lab in Washington State, paid local labs … [Read more...]

HEALTH CARE REFORM

Compliance Perspectives: PAMA Pitfalls & Survival Strategies

PAMA's deep Medicare reimbursement cuts have had a devastating impact on the lab industry. Recent CMS changes in the 2019 Final Rule should provide a degree of pricing relief but not until 2021. In … [Read more...]


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