Case of the Month: False Billing of Nuclear Stress Tests at Center of $50 Million Cardio Fraud Scheme

The feds arrested a cardiologist, neurologist and four others for their role in an elaborate fraud scheme. The government contends that over a 12- year period, the defendants' New York City medical … [Read more...]


Notorious File: Feds Take Down Three More Doctors in BLS Lab Bribery Scheme

The Biodiagnostic Laboratory Service (BLS) case continues to be the poster child for the evils of fraud and greed in the health care industry, generating record numbers of prosecutions against medical … [Read more...]


CMS, OIG Reps Address PAMA, Fraud Enforcement at ACLA Annual Meeting

At the American Clinical Laboratory Association annual meeting in Washington, D.C. March 23, representatives of the Centers for Medicare & Medicaid Services (CMS) and the Office of Inspector … [Read more...]


OIG and DOJ Provide Tips for Determining Effectiveness of Compliance Programs

Labs have two new compliance tools—from the Department of Justice (DOJ) and the Office of Inspector General (OIG)—focused on evaluating the effectiveness of compliance programs. The DOJ's resource … [Read more...]


Breach Notification Violation Ends in $475,000 Settlement

Patient health information breaches—whether from hacking, glitches or just plain old carelessness—remain an all too common occurrence in labs and other health care institutions. Three years ago, a new … [Read more...]


OIG Updates Threshold for Nominal Value Gifts

Just as the civil monetary penalties have gotten an update to adjust for inflation (see "Civil Monetary Penalties Rules Updated" Lab & Pathology Insider, Jan. 3, 2017), so too have the thresholds … [Read more...]


DOJ Surveys False Claims Victories for 2016

As we closed out the calendar year, the U.S. Department of Justice (DOJ) reflected on its successes for the fiscal year 2016 (FY 2016) which ended Sept. 30, 2016. Principal Deputy Assistant Attorney … [Read more...]


Labs Beware: New Rules Impose Harsher Civil Monetary Penalties

It may be facing repeal but the Affordable Care Act (ACA) is not going down without a squawk. On Dec. 7, the Office of Inspector General (OIG) accomplished a key piece of ACA business by adopting … [Read more...]


New OIG Advisory Opinion Repeats Warning that Free Labeling Services Can Be Kickbacks

The government's longstanding aversion to labs providing free items or services to referral sources remains unaffected by changes in reimbursement methods. A laboratory sought an advisory opinion from … [Read more...]


2017 OIG Work Plan Holds Few Surprises for Labs

There are few surprises in the Health and Human Services Office of Inspector General's 2017 Work Plan. The OIG's annual Work Plan provides a summary of new and continuing reviews that the agency is … [Read more...]