FALSE CLAIMS

Florida Doctor Jailed 5 Months for Lying to a Medicare Auditor

Lying to a Medicare auditor or otherwise obstructing a Medicare audit is a crime that can get you jailed. A 73-year-old endocrinologist specializing in diabetes management just learned that lesson the … [Read more...]

HOSPITAL OUTREACH

Case of the Month: Fraud or Legitimate Rural Hospital Lab Outreach Business?

A North Carolina lawsuit pitting one of the nation's largest health insurers and a national hospital management company raises novel legal issues that test the legal limits of provider contracts … [Read more...]

CYBERSECURITY

Case of the Month: Alabama Hospital Lab Settles Data Breach Class Action Suit

Class action lawsuits by patients victimized by data breaches have become increasingly common. And, more often than not, they prove unsuccessful. But a recent case involving Flowers Hospital in … [Read more...]

SETTLEMENT

Connecticut Hospital Settles Self-Disclosed Stark Violations for $423K

Case: A major settlement in Connecticut in June was authored by Hartford Hospital after it made the mistake of leasing office space to a physician practice (and Medicare referral source) at below … [Read more...]

COMPLIANCE

Enforcement Trends: New Fraud Takedown Focuses on Opioid Drugs & Sophisticated Financial Schemes

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...]

REIMBURSEMENT

Enforcement Trends: OIG Report Suggests that Urine Drug Testing Is Making Labs a Juicy Target Once Again

The Office of Inspector General just published its Semiannual Report to Congress (covering Oct. 1, 2017 through March 31, 2018). Here are the key things labs and lab managers need to know about this … [Read more...]

COMPLIANCE

Enforcement Trends: Private Insurers Are Cracking Down on the Labs that Scam Them

Once the almost exclusive domain of federal law enforcers and inside whistleblowers, the lucrative industry of going after labs for improper billing has opened to a wide range of players encompassing … [Read more...]

COMPLIANCE

Medicaid Fraud: Enforcement Continues to Trend Down as Labs Drift Deeper into the Background

Last month, the OIG published its annual summary of Medicaid Fraud Control Unit (MCFU) activity for FY 2017. Here is a summary of the key findings, trends and impact on labs. Background The 50 MCFUs … [Read more...]

ENFORCEMENT

Case of the Month: $33.2 Million Alere Settlement Sends Warning Shot Across Bow of LDT & DX Device Makers

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

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...]


(-0000g2)