DATA

6 Steps to Data-Driven Transformation

By Nir Kaldero  bio We're now well into the Fourth Industrial Revolution. The First Industrial Revolution was about steam and railroads, the Second about electricity, and the Third brought … [Read more...]

OVERPAYMENTS

Rural Hospital Lab Outreach or Fraudulent Overreach?

Case: In February 2017, hospital management firm LifeBrite paid $400K to acquire a bankrupt rural outreach hospital in North Carolina with network status in Blue Cross Blue Shield North Carolina (BC). … [Read more...]

FEE SCHEDULES

Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017

According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in 2017, the last year under the pre-PAMA payment system, totaled $7.1 billion, up slightly from the $6.8 billion … [Read more...]

ENFORCEMENT

Opko Health, CEO Named in Pump-and-Dump Stock Fraud Scheme

Case: The U.S. Securities Exchange Commission charged billionaire drug entrepreneur Phillip Frost and his company, Opko Health, for participating in a market manipulation scheme allegedly organized by … [Read more...]

PATIENT SAFETY

Lab CEO Pleads Guilty to Distributing Medically Unnecessary Opioids

Case: The CEO of Tri-County Wellness Group and owner of labs and pain clinics in Michigan and Ohio, pleaded guilty to criminal charges for his role in $300 million health care fraud scheme involving … [Read more...]

MANAGING STAFF

Compliance Perspective: The Duty to Accommodate the Religious Beliefs of Employees & Job Applicants

YOU MAKE THE CALL SITUATION: A worker notifies management that he can't comply with hospital policy requiring all workers to get an annual flu shot because of his religion. He asks for permission to … [Read more...]

COMPLIANCE TIPS

Surviving a Medicare Audit: Warn Lab Staffers Not to Lie to Auditors

As a lab compliance director, you understand the dangers of obstructing a Medicare audit. The problem is you staff may not. So, make it clear to any staffer that may come into contact with an auditor … [Read more...]

HIPAA

Aetna Settles with States of Victims of HIV Meds Envelope Privacy Snafu

Case: Aetna is still paying for a disastrous miscalculation that may have revealed the HIV status of 12,000 beneficiaries that occurred in July 2017 when it mailed them information about their HIV … [Read more...]

OUTREACH ASSETS

Attendees Given Insider’s Look at a Hospital Laboratory Joint Venture

Hospital systems are increasingly exploring joint ventures as a means to monetize some of the hospital outreach laboratory's assets without exiting the business. Attendees at G2's 36th annual … [Read more...]

ANTI-KICKBACK

Florida MD Practices Shell Out $58.3K for Accepting Millennium Test Cup Freebies

Case: The round-up of physicians that accepted free point of care test (POCT) cups from Millennium Laboratories continues with a pediatrician and internist and their respective Jacksonville … [Read more...]


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