NEWS

Government Shutdown: The Impact on the Agencies that Regulate Labs

As we go to press, the longest U.S. government shutdown in history drags on with no end in sight. And while it may not affect your lab directly, the shutdown will have an indirect impact to the extent … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: January 2019

This month, there were six new Work Plan items. The two pertaining to labs are detailed below. The first one has widespread implications for labs; the second may have implications for some labs 1. … [Read more...]

REIMBURSEMENT

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

Tennessee Pain Doctor Faces Jail for Opioid Abuses, Medicare Fraud Case: The doctor is facing 45 charges, including 22 counts of illegal distribution of a controlled substance for routinely … [Read more...]

PAMA

Medicare Reimbursement: CMS Provides Needed PAMA Relief—But Newly Covered Hospital Labs Must Report in 2019

The battle between CMS and the lab industry over Medicare Part B pricing for lab tests could be on the road to resolution notwithstanding the ACLA's recent court loss. But even as the legal battle … [Read more...]

ENFORCEMENT

Provider Fined for Not Taking Compliance Measures Required by Its CIA

Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]

LEGISLATION

New Broad All-Payor Kickback Law Impacting Laboratories, Commission-based Compensation and more

By Danielle Sloane bio and Chris Climo bio In a recent piece of federal legislation intended to address the opioid crisis across the United States, Congress enacted a new all-payor kickback … [Read more...]

BILLING AND COLLECTIONS

Texas Lab and Owner Get 15-Year Exclusion for Medicare Mileage Swindle

Case: What would you do if your bill for a $43 blood test included a $1,500 travel fee? The patient who actually received such a bill from Texas lab BestCare complained to the government. The … [Read more...]

LEGISLATION

Compliance Alert: New Private-Pay Opioid Law Puts All Drug Addiction & Rehab Labs at Risk of Federal Prosecution

Recent federal legislation addressing the opioid crisis may have unintended consequences on the lab industry. The idea was to allow the feds to prosecute a certain kind of abuse banned by the … [Read more...]

FALSE CLAIMS

Florida Lab Owners Convicted for Role in Notorious Drug Distribution Scheme

Case: The two brothers who own a Palm Beach lab pleaded guilty to health care fraud for their role in the illegal drug distribution conspiracy carried out by notorious sober home operator Kenny … [Read more...]

HEALTH CARE REFORM

Case of the Month: Texas Court Strikes Down Obamacare—So, Now What?!

What came as a Christmas gift to many Republicans could be a lump of coal in the stockings of health insurers and the patients they cover. On Dec. 14, a federal judge in Texas did the unthinkable by … [Read more...]


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