Amid all the talk of sweeping reform of the health insurance marketplace, the smaller, interim changes get overlooked despite their direct impact on labs and other providers. Two such changes took … [Read more...]
HEALTH CARE REFORM
Health Insurance Market: Two Recent Changes & Their Impact on Labs
October 1, 2018
HOSPITAL OUTREACH
Case of the Month: Fraud or Legitimate Rural Hospital Lab Outreach Business?
September 26, 2018
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...]
ANTI-KICKBACK
Case of the Month: Individual Principles Hit with $114.1 Million Verdict for Role in HDL Blood Test Fraud
July 3, 2018
Roughly three years ago at this time, mega-scandals were in the news featuring diagnostic giants like Millennium, Health Diagnostic Laboratory (HDL), Biodiagnostic Laboratory Service and the like. But … [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...]
HEALTH CARE REFORM
Medicare Reimbursement: Federal Government Funding Extension Includes a Boatload of Medicare Changes
February 26, 2018
The government shutdown fiasco is having an impact on Medicare spending and reimbursement. But the crucial details are being buried in the legislative paperwork. So we decided to ferret them out for … [Read more...]
NEWS
Case of Month: Using Window Envelope to Mail HIV Info Costs Aetna $17+ Million
February 13, 2018
You talk about a mailroom mess-up! A shockingly bad choice in envelopes has just cost one of the country's largest health insurers over $17 million. The Lawsuit On Jan. 16, Aetna agreed to pay … [Read more...]
FOCUS ON
CLIA: After 36 Years, CMS Gives Lab Accreditation a Good Hard Look
January 16, 2018
"May you live in interesting times." If you've been in the clinical labs business for a while, you probably appreciate the wisdom behind this ancient Chinese curse. 2018 is shaping up to be a very … [Read more...]
ANTI-KICKBACK
Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry
November 16, 2017
Opioid Subscribing Doctor Convicted in Lab Referral Kickback Scam Case: Two doctors at a Maryland pain management clinic that prescribed pain relief medications to patients accepted kickbacks to … [Read more...]
EMPLOYMENT LAW
Employment Law Update for HR Managers October 2017
November 6, 2017
By Mike O'Brien bio Here is my periodic update prepared for interested HR professionals trying to deal with the complex American employment laws. In this update: Federal agencies take … [Read more...]
