ENFORCEMENT

Enforcement Trends: False Claims Act Recoveries Increase as Labs Remain in Firing Line

The dollars paid by healthcare providers in federal False Claims Act settlements and judgments increased for the second year in row in 2019. After a surprising decline in 2017, total recoveries … [Read more...]

ENFORCEMENT

Enforcement Trends: The Top 5 Lab False Claims Act Settlements of 2019

Labs were on the paying end of at least eight million-dollar False Claims Act (FCA) settlements or judgments in the 2019 fiscal year. Here’s a review of the top 5 reported FCA recoveries against a lab … [Read more...]

Billing & Collections

Finding the “Backdoor” into Payer Networks

By Steve Selbst bio  I am delighted to be able to share with you a key “secret to success” about payer contracting. Today’s article is about getting in the “backdoor” with payers and complementing … [Read more...]

Current Issue of NIR

Before You Download Please read the following user agreement and confirm your acceptance of the terms before you download NIR content: I agree that I am the the only person who is accessing my … [Read more...]

Employment Law Update

New overtime rule now in effect

By Mike O’Brien bio Jan. 1, 2020 was the deadline to comply with new FLSA overtime rule. At the end of September the Department of Labor issued its long-awaited final rule updating the salary … [Read more...]

Maximum Civil Monetary Penalties Increase in 2020

Every year, HHS adjusts the maximum civil monetary penalty (CMP) amounts that a lab or other provider can be fined for inflation. In 2020, CMP maximums will increase by 2.522%. The new higher CMP … [Read more...]

In Brief: OIG Opens Second Avenue for Anti-Kickback Statute Revisions

Even as we wait for the second draft of the proposed new value-based kickback relief rules—see National Intelligence Report (NIR), Nov. 15, 2019—the OIG issued its annual call for recommendations for … [Read more...]

 FDA Targets Sale of IVD Reagents without Premarket Approval

Distribution of diagnostics and devices without premarket approval has featured prominently on the FDA’s enforcement priority list this year. The agency has issued seven warning letters related to … [Read more...]

REIMBURSEMENT

By the Numbers: Improper Medicare Payments Hit 10-Year Low

As 2019 came to an end, CMS announced that the rate of improper Medicare payments during the year continued to decline, hitting its lowest point since 2010. Here are some of the key numbers: … [Read more...]

HEALTH CARE REFORM

ACA: Still Here Today but for How Much Longer?

Is Obamacare really dead? Only partially dead? Or is it totally alive? It’s all pretty confusing. But the short answer is that Obamacare lives and will continue to do so unless and until the U.S. … [Read more...]


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