CMS Ignores Flawed Processes, Finalizes 2018 PAMA Pricing; Labs Need to Take Immediate Action to Offset Impending Lean Times

By Kyle Fetter  bio The final 2018 clinical laboratory fee schedule (CLFS) is out, and it is evident that the argument that the Centers for Medicare & Medicaid Services (CMS) PAMA … [Read more...]


Case of the Month: Lab Tests Play Key Role in $19 Million Detroit Opioid Scheme

A physician just pleaded guilty to ordering millions in medically unnecessary lab tests? So what else is new? Please pass the butter… Granted, stories like the Oct. 12 guilty plea of that physician … [Read more...]


Case of the Month: FMC Settlement Is Poster Child for False Billing of Lab Tests

In the grand scheme of things, $2 million is fairly small potatoes for false billing of lab tests—especially considering that it allegedly went on for 10 years. Even so, if you're running your lab's … [Read more...]


That CAN’T Be Right: Court Says Labs Must Independently Verify Medical Necessity of M.D. Ordered Tests

Based on the enforcement track record, if your lab ever gets charged with falsely billing Medicare for lab tests, failure to document the medical necessity of the ordered tests will be the reason. … [Read more...]


Draft 2018 CLFS Reveals Fundamental Flaws in PAMA Reporting Exercise; Time to Take Action

By Lâle White  bio As XIFIN predicted, the PAMA reporting exercise has resulted in significant proposed laboratory fee cuts. In fact, the multi-year decrease for the top 20 laboratory tests … [Read more...]


OIG Work Plan Monthly Review: August 2017

Two months into its new monthly update regime, the OIG added 4 new items to its Work Plan in August, none of which will have a direct impact on laboratory services. However, 3 of the initiatives may … [Read more...]


Consortium Releases New Interoperability Standard for Lab IT Systems

With the release of a new information technology (IT) standard, the dream of true interoperability of electronic health care information has gotten one step closer to reality. The new standard, called … [Read more...]


The Latest Medicare Fraud Takedown: New Administration, Same Enforcement Strategy

Although the Obama Justice Department didn't invent coordinated health care fraud enforcement, it did advance the strategy more than any previous administration. So when the Trump crew took over, some … [Read more...]


Clinical Laboratories Continue to Figure Less Prominently in New OIG Enforcement Report

The Office of Inspector General just published its most recent Semiannual Report to Congress. To the untrained eye, the newest OIG Report, which covers Oct. 1, 2016 through March 31, 2017, is not … [Read more...]


CMS Dished Out $729.4 Million in Wrongful EHR Incentive Payments & We’re Going to Get that Money Back

Wrongful payments of Electronic Health Records (EHR) incentives are at the focus of two of the month's biggest stories in health care compliance. The first came down on May 31 when the Justice … [Read more...]