In 2018, the Justice Department (DOJ) ordered US Attorneys to aggressively seek dismissal of False Claims Act (FCA) whistleblower qui tam lawsuits that lack merit or don’t serve the government’s … [Read more...]
False Claims
The Liability Risks of Failing to Report Tests of Dubious Medical Necessity
February 22, 2021
What should your lab do if providers order tests that clearly don’t meet coverage criteria for medically necessary coverage criteria? A recent settlement involving Cordant Health Solutions charges of … [Read more...]
Enforcement Trends
After 5 Down Years, Federal Enforcement ROI Increases—But Just a Tad
August 12, 2020
Like any other business, federal health care fraud law enforcement has to account for its return on investment (ROI). And for the previous six years, that ROI had been in steady decline. But ROI … [Read more...]
Case of the Month
Feds Launch First COVID-19 Testing Fraud Prosecution
July 3, 2020
Stop me if you’ve heard this one before. The DOJ has charged a publicly traded Silicon Valley med tech firm and its CEO with touting a sham finger stick blood test to defraud payors and rip off … [Read more...]
Labs In Court
WV Hospital & Marketer Accused of Elaborate Kickback Scam
March 23, 2020
Case: A new DOJ lawsuit accuses a West Virginia non-profit hospital and its business consultant of seeking to dominate the Ohio Valley market by bribing physicians for referrals. The scheme began in … [Read more...]
DOJ
Enforcement Trends: New DOJ Policy Targeting Whistleblowers with Weak Cases May Make Life Easier for Labs
March 4, 2019
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...]
BRIBES
Labs with International Aspirations Need to Focus on FCPA Compliance Challenges
May 12, 2016
Laboratories are very familiar with the Anti-Kickback Statute and its prohibitions against payments to induce referrals. Laboratories and diagnostics companies looking at global opportunities should … [Read more...]
