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...]
BILLING & CODING
Medicare Reimbursement: CMS Begins Implementing New HOPPS Date of Service Rules for ADLTs & Molecular Pathology Tests
August 13, 2018
CMS has begun implementing the new rules that exempt advanced diagnostic laboratory tests (ADLTs) and molecular pathology tests from Medicare Hospital Outpatient Prospective Payment System (HOPPS) … [Read more...]
LITIGATION
Are Genetic Testing Labs Liable for Medical Malpractice?
July 30, 2018
Consumer-based genetic testing has become a $3 billion business with a seemingly limitless future. But the industry is also facing a legal threat to future growth: malpractice liability. In the past … [Read more...]
STARK LAW
CMS Mulls Stark Law Relief: This Time It May Be for Real
July 16, 2018
After decades of complaining about the Stark Law, the lab industry may now have an actual opportunity to secure meaningful relief. On June 20, CMS issued a Request for Information (RFI) seeking input … [Read more...]
DATA
Case of the Month: Patients Can’t Sue Labs for Privacy Breaches, Federal Court Confirms
July 13, 2018
The HIPAA law sets out civil and criminal penalties that can be imposed on labs (and other providers) that commit privacy violations. But one thing the HIPAA law does not specify is whether an … [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...]
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...]
REIMBURSEMENT
Enforcement Trends: OIG Report Suggests that Urine Drug Testing Is Making Labs a Juicy Target Once Again
June 19, 2018
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...]
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...]
