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...]
The Liability Risks of Failing to Report Tests of Dubious Medical Necessity
After 5 Down Years, Federal Enforcement ROI Increases—But Just a Tad
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...]
Feds Launch First COVID-19 Testing Fraud Prosecution
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...]
WV Hospital & Marketer Accused of Elaborate Kickback Scam
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...]
Enforcement Trends: New DOJ Policy Targeting Whistleblowers with Weak Cases May Make Life Easier for Labs
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...]
Labs with International Aspirations Need to Focus on FCPA Compliance Challenges
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...]