Special Report

Final Rules Offer Real Stark and Kickback Relief but Largely Exclude Labs

With its time apparently running out, the Trump administration completed one of its pet projects by finalizing the kickback reform rules it proposed in October 2019. Issued on Nov. 20, the new final … [Read more...]

Labs in Court

Texas Court Nixes Toxicology Labs’ ERISA Beneficiary Unpaid Claims Lawsuit against United Healthcare

Case: After United Healthcare denied their claims, plan members assigned their benefits to a pair of toxicology labs who then filed a lawsuit to against United under the federal Employee Benefits … [Read more...]

Innovation

New Artificial Intelligence-Based Risk Score May Help Avoid Unnecessary COVID-19 Hospitalizations

Researchers at Massachusetts General Hospital (MGH) have developed a diagnostic tool that uses artificial intelligence to generate a score to assess the prognosis of individual patients diagnosed with … [Read more...]

Industry Trends

Surging COVID-19 Cases Are Pushing Laboratories to the Breaking Point

Long lines for testing. Shortages of critical testing supplies. Case backlogs and long reporting delays. Laboratories across the country and the patients they serve are reliving the nightmares of … [Read more...]

Labs in Court

Pain Management Network Shells Out $1 Million to Settle Lab Testing Kickback Charges

Case: The DOJ accused a collection of companies owned by Wisconsin-based Advanced Pain Management Holdings, Inc. (APMH) of paying kickbacks in the form of shares of company stock to non-employee … [Read more...]

Enforcement Scorecard

The HIPAA Information Access Rights Crackdown Continues

The face of federal HIPAA enforcement has changed in a subtle but significant way in the past 18 months. Historically, the focus has been all about keeping personal health information (PHI) private … [Read more...]

Whistleblowers:

Lab that Ignores Employee’s Billing Concerns Settles FCA Case for $43 Million

One of the costliest False Claims Act settlements involving lab tests in recent years is still one more cautionary tale of how dismissing the reports of lab employees who come forward to express … [Read more...]

Labs In Court

Out-of-Network Drug Testing Labs Can Sue UnitedHealthcare for Inadequate Reimbursement

 Case: A group of out of network labs and substance abuse clinics sued UnitedHealthcare for reimbursing them only 19.5% of covered charges on 1,306 insureds that had already met their annual … [Read more...]

Labs In Court

Pennsylvania Medical Assistants Confess to Participating in Genetic Test Fraud Scheme

  Case: Federal and state enforcers are closing in on a Pennsylvania primary care physician who allegedly ripped off Medicare for genetic tests to the tune of $755,241. At the center of the scheme is … [Read more...]

M&A Report

Exact Sciences Makes a Bold Double Play to Bolster Its Early Cancer Detection Capabilities

Although volume was light, October was a robust month for M&A deal making in terms of impact, especially in the cancer diagnostics space. The month started with the announcement of Invitae’s … [Read more...]


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