BILLING AND COLLECTIONS

Aetna Sues Manager of Oklahoma Rural Hospital for Lab Test Ripoff

Case: People's Choice, a management firm specializing in turning around financially strapped hospitals, is being sued by Aetna for using an Oklahoma rural hospital client to carry out an elaborate lab … [Read more...]

CORRECTION

Correction: PAMA Relief—CMS 1450 14x TOB Labs DO Count!

Two articles appearing on the G2 website, "CMS Offers Some PAMA Relief But Not Nearly Enough" (G2 Compliance Advisor/Lab Compliance Advisor) and "2019 CLFS Offers Some PAMA Relief But Not Nearly … [Read more...]

UTILIZATION MANAGEMENT

You Make the Call: Incentivizing MDs to Order More Early Screening Tests

A Managed Care Organization (MCO) wants to pay providers incentives to increase early and periodic screenings, diagnostic and treatment (EPSDT) services to Medicaid patients. Payments are capitated, … [Read more...]

ANTI-KICKBACK

Massachusetts Lab Fined $1.374 Million for Free Test Supplies Kickback Scam

Case: A federal court ordered Calloway Laboratories, Inc. to pay $1,374,058 to settle claims of falsely billing Medicare and TRICARE for urine drug tests over a six-month period in 2014. As part of … [Read more...]

COMPLIANCE GUIDANCE

Compliance Perspectives: Avoid Kickback Liability by Steering Clear of MD Processing Fees

Editor's Note: Two months ago, we talked about paying referring physicians a fee for collecting and processing blood, urine, tissue and other specimens. (G2 Compliance Advisor, Oct. 9, 2018, p. 1). … [Read more...]

ANTI-KICKBACK

Jail for Urine Drug Testing Kickback Co-Conspirators

Case: Urine samples produced by patients of a Maryland-based pain clinic were a billables gold mine for a Jersey City testing lab, well worth the $1.37 million in kickbacks it ultimately paid to … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: November 2018

This month, there were six new Work Plan items, two of which have implications for at least some labs. 1. CDC's Oversight of the President's Emergency Plan for AIDS Relief Funds Issue: Through the … [Read more...]

FALSE CLAIMS

Free Testing Supplies to Physicians Costs Massachusetts Lab $1.374 Million

Case: A federal court ordered Calloway Laboratories, Inc. to pay $1,374,058 to settle claims of falsely billing Medicare and TRICARE for urine drug tests over a six-month period in 2014. As part of … [Read more...]

CONSUMER FRAUD

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

New York Doctor Busted for Falsely Billing Medicaid for Lab Drug Tests Case: The State claims that the physician billed for $939,000 worth of drug testing services that his lab didn't and … [Read more...]

COMPLIANCE CORNER

HIPAA Compliance: The Pitfalls of PHI De-Identification & How to Avoid Them

In 2016, the Australian government released medical billing records of 2.9 million people. They tried to protect patient privacy by removing names and other identifying data. But it didn't work. … [Read more...]


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