Although it's still a profitable endeavor, enforcing federal health care fraud laws isn't providing the investment returns of yesteryears. That's the main takeaway of the new joint HHS and … [Read more...]
ENFORCEMENT
Enforcement Trends: Investment Return on Fraud Fighting Continues to Decline
July 22, 2019
COMPLIANCE
DOJ Explains What It Wants from a Compliance Program
June 17, 2019
While it may not prevent all violations, the right compliance program can help your lab get lighter penalties if things go wrong. But what exactly is "the right compliance program." On April 30, the … [Read more...]
EXPOSED THERANOS FRAUD
Investigative Journalist Wins Kellison Award
October 25, 2018
John Carreyrou, the Pulitzer prize-winning journalist who exposed Theranos as a fraud, was presented with the Kellison & Company Distinguished Service Award at Lab Institute today. Pictured … [Read more...]
ENFORCEMENT
CMS Takes 3 New Measures to Bolster Medicaid Program Integrity
August 20, 2018
With Medicaid spending on the rapid ascent, CMS unveiled a trio of new initiatives to bolster program integrity and make states more accountable for compliance with federal rules. 1. MLR Audits CMS … [Read more...]
COMPLIANCE
Enforcement Trends: New Fraud Takedown Focuses on Opioid Drugs & Sophisticated Financial Schemes
July 13, 2018
The 2016 health care fraud takedown was the biggest in history; the 2017 version surpassed it; and the June 2018 reprise nearly doubled the 2017 effort, at least in terms of the false claims dollars … [Read more...]
DOJ
Criminal Charges May Spell the End for Theranos
July 13, 2018
Four years ago, Theranos was a $10 billion company poised to turn a breakthrough blood testing technology into a diagnostics dynamo to the tune of $70 billion in annual sales. Today, the company … [Read more...]
HEALTH CARE REFORM
ACA: DOJ Won’t Defend Individual Mandate in Court—But 16+ States Will
June 18, 2018
One of the DOJ's principal roles is to defend the federal laws in court cases challenging their constitutionality. But the agency has made it known that it will not be doing that in a lawsuit brought … [Read more...]
ENFORCEMENT
Case of the Month: $33.2 Million Alere Settlement Sends Warning Shot Across Bow of LDT & DX Device Makers
April 23, 2018
One of the reasons Abbott Laboratories got cold feet about consummating the $5.3 billion Alere acquisition was concern over the legal proceedings against the target firm. Now one of those cases … [Read more...]
COMPLIANCE
Physician Referrals: New Rules Offer Some Stark Law Relief but Not Nearly Enough
April 11, 2018
Like most budget bills, the new federal Bipartisan Budget Act of 2018 includes a number of changes to Medicare fraud and enforcement requirements. One set of changes affects the current physician … [Read more...]
FOCUS ON
New Laws: Very Quietly, Congress Doubles Penalties for Medicare Fraud & Abuse
April 10, 2018
Sneaky may be too strong a word. But what is fair to say is that the new hikes in federal health care fraud violation penalties have flown totally under the radar despite their obvious and immediate … [Read more...]
