ANTITRUST

Enforcement Trends: New Emphasis on MD Practices Puts Labs at Growing Risk of Antitrust Enforcement

In addition to the usual Medicare and Medicaid anti-fraud laws, labs have a new liability risk to contend with: stepped-up federal and state enforcement of antitrust laws. The driving force behind … [Read more...]

CODING

Urgent Care Centers Settle E/M Upcoding Charges for $2 Million

Case: The owners/operators of CareWell urgent care centers in Massachusetts and Rhode Island have agreed to shell out $2 million for improper coding of Evaluation and Management services. CPT code … [Read more...]

PAMA

Explaining the Legal News: Why ACLA Court Win Boosts Chances of PAMA Pricing Relief

By now, you've no doubt heard the news that the American Clinical Laboratory Association (ACLA) "won" its lawsuit against CMS over PAMA lab pricing. Only it's not as simple as that. The favorable US … [Read more...]

COMPLIANCE

Genetic Testing Fraud Prosecutions are on the Rise around the Country. Are Your Genetic Testing Practices Compliant?

By Robert Liles bio Over the last year, a number of genetic testing fraud investigations and prosecutions have been initiated by Medicare, Medicaid and TRICARE investigators and auditors. While … [Read more...]

ANTI-KICKBACK

Texas Scammer Gets 20 Years for Role in $50 Million Lab Test Ripoff

Case: The plot unfolded 10 years ago when a then 26-year-old woman and three co-conspirators set up 24 phony diagnostic testing centers in Houston. Offices were rented in 28 locations even though none … [Read more...]

OPERATIONS

Lab Management: Billing Company Contract Liability Risks & How to Avoid Them

Like many labs, you may outsource your billing and coding to an outside medical billing company. While this might be cost-effective, be aware that it can put your lab at risk for liability under … [Read more...]

Texas Health System Fined $431K for Falsely Billing Genetic Tests

Case: The feds contend that between 2016 and 2018, Decatur Hospital Authority (d/b/a Wise Health System) sent samples from surgical patients to Tennessee labs for medically unnecessary genetic tests. … [Read more...]

ANTI-KICKBACK

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

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 … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: August 2019

Of the 12 new items in the OIG's Work Plan this month, six indirectly impact lab providers and services. Medicare Payments of Positive Airway Pressure (PAP) Devices for Obstructive Sleep Apnea (OSA) … [Read more...]

COMPLIANCE

Compliance Perspectives: What to Do When Respiratory Safety & Religious Rights Collide

THE SCENARIO A lab requires all employees who work with or near materials emitting toxic vapors to wear respirators with tight-fitting facepieces. Since facial hear interferes with a tight seal, … [Read more...]


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