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...]
COMPLIANCE
Case of the Month: False Billing of Nuclear Stress Tests at Center of $50 Million Cardio Fraud Scheme
June 19, 2017
ENFORCEMENT
Notorious File: Feds Take Down Three More Doctors in BLS Lab Bribery Scheme
June 14, 2017
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...]
ENFORCEMENT
CMS, OIG Reps Address PAMA, Fraud Enforcement at ACLA Annual Meeting
March 31, 2017
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...]
COMPLIANCE
OIG and DOJ Provide Tips for Determining Effectiveness of Compliance Programs
March 31, 2017
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...]
HIPAA
Breach Notification Violation Ends in $475,000 Settlement
January 23, 2017
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...]
COMPLIANCE
OIG Updates Threshold for Nominal Value Gifts
January 6, 2017
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...]
FALSE CLAIMS
DOJ Surveys False Claims Victories for 2016
January 3, 2017
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...]
COMPLIANCE
Labs Beware: New Rules Impose Harsher Civil Monetary Penalties
December 22, 2016
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...]
COMPLIANCE
New OIG Advisory Opinion Repeats Warning that Free Labeling Services Can Be Kickbacks
December 22, 2016
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...]
ENFORCEMENT
2017 OIG Work Plan Holds Few Surprises for Labs
November 25, 2016
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...]
