COMPLIANCE

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...]

NEWS

Electronic Health Records: The eClinicalWorks False Claims Settlement—Big Fines & Unprecedented CIA Obligations

False Claims Act actions targeting health care vendors have become more common. eClinicalWorks (ECW), one country's biggest electronic health records software vendors, learned that lesson the hard way … [Read more...]

Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry

Quest Fined for Self-Disclosed Violations for Second Time in 2017. Case: Quest Diagnostics, Inc., New Jersey agreed to pay over $1.151 million for three Civil Monetary Penalties Law … [Read more...]

ENFORCEMENT

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...]

BILLING & CODING

Reimbursement Trends: 5 More New Molecular Tests Get the Medicare Green Light from Palmetto

Normally among the slowest payors to accept promising but unproven new tests, Medicare continues to loosen the reins for molecular assays. In May, Palmetto GBA (Columbia, SC), one of Medicare's most … [Read more...]

ENFORCEMENT TRENDS

Enforcement Trends: Labs Get Cameo, Rather than Starring Role in OIG’s New Enforcement Report

The Office of Inspector General just published its Semiannual Report to Congress (covering Oct. 1, 2016 through March 31, 2017). It's mostly more of the same other than the fact that, for once, … [Read more...]

LEGISLATION

New Laws: House Bans Firing Whistleblowers for Disobeying Orders to Break the Law

It's clearly against the law to fire an employee in retaliation for filing a whistleblower suit against your lab. So it goes without saying that the ban on retaliation also prevents you from firing an … [Read more...]

ENFORCEMENT

Compliance Scorecard: Significant New HIPAA Fines

Health data and information security figured prominently in May enforcement activity. In addition to the blockbuster eClinicalWorks EHR software settlement discussed on page 3, there was an unusually … [Read more...]

INFECTIOUS ILLNESSES

CDC Updates Zika Testing Recommendations

The U.S. Centers for Disease Control and Prevention (CDC) issued a Health Alert Notice with updated guidance for testing women who live in or frequently travel to areas with a CDC Zika travel notice. … [Read more...]

DOJ

Medical Necessity Requirement Bites Anatomic Pathologists

By Robert Mazer  bio The DOJ has announced two separate settlements involving claims for allegedly unnecessary special stains. Medicare permits a pathologist to order special stains when … [Read more...]


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