CMS

Lab Fails in Bid to Get Medicare Payment Suspension Set Aside

Case: In 2017, CMS suspended 100% of Medicare payments to True Health Diagnostics (THD) based on what it called “credible allegations of fraud.” Two years later, while the suspension was still in … [Read more...]

FALSE CLAIMS

Federal Court Dismisses Urine Drug Test False Billing Claim

Case: Whistleblowers accused a national lab company of falsely billing Medicare and Medicaid for high complexity quantitative urine drug tests under CPT code G0431 at up to $476 per test. According to … [Read more...]

Labs In Court

A roundup of recent cases and enforcement actions involving the diagnostics industry ACLA Goes for Knockout Punch in PAMA Lawsuit  Case: Having survived a first-round setback, the American … [Read more...]

MARKETING

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 federal court tossed their class action ruling that the patients didn’t have a valid … [Read more...]

ANTI-KICKBACK

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

Quest Pays $88.7K to Settle Specimen Collection Fee Kickback Charges Against Its Subsidiary Case: After self-disclosing, Quest has settled kickback claims against its wholly-owned subsidiary, … [Read more...]

ANTI-KICKBACK

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 Ohio Valley market by bribing physicians for referrals. The scheme began in … [Read more...]

ENFORCEMENT

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 Virginia Medicaid for opioid-related tests. The DOJ claims that over a six-year … [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...]

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...]

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...]


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