Case: The owners/operators of CareWell urgent care centers in Massachusetts and Rhode Island have agreed to shell out $2 million for improper coding of Evaluation and Management services. CPT code … [Read more...]
COMPLIANCE
Genetic Testing Fraud Prosecutions are on the Rise around the Country. Are Your Genetic Testing Practices Compliant?
September 10, 2019
By Robert Liles bio Over the last year, a number of genetic testing fraud investigations and prosecutions have been initiated by Medicare, Medicaid and TRICARE investigators and auditors. While … [Read more...]
ANTI-KICKBACK
Texas Scammer Gets 20 Years for Role in $50 Million Lab Test Ripoff
September 6, 2019
Case: The plot unfolded 10 years ago when a then 26-year-old woman and three co-conspirators set up 24 phony diagnostic testing centers in Houston. Offices were rented in 28 locations even though none … [Read more...]
OPERATIONS
Lab Management: Billing Company Contract Liability Risks & How to Avoid Them
September 3, 2019
Like many labs, you may outsource your billing and coding to an outside medical billing company. While this might be cost-effective, be aware that it can put your lab at risk for liability under … [Read more...]
Texas Health System Fined $431K for Falsely Billing Genetic Tests
August 30, 2019
Case: The feds contend that between 2016 and 2018, Decatur Hospital Authority (d/b/a Wise Health System) sent samples from surgical patients to Tennessee labs for medically unnecessary genetic tests. … [Read more...]
ANTI-KICKBACK
Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry
August 28, 2019
LabCorp Must Go to Trial to Defend against Deceptive Trade Practices Charges Case: Fourteen patients sued LabCorp for allegedly overcharging them for lab tests. In March 2018, a North Carolina … [Read more...]
COURT CASES
Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry
August 26, 2019
Federal Court Dismisses Whistleblowers' Urine Drug Test False Billing Claim Case: Whistleblowers accused a national lab company of falsely billing Medicare and Medicaid for high complexity … [Read more...]
CMS
Kickbacks: OIG Withdrawal of Old Safe Harbor Proposals Clears Way for Meaningful Reform
August 26, 2019
Like the rest of the health care industry, labs need more not fewer new and modern Anti-Kickback Statute (AKS) safe harbors. So, the OIG's decision to cancel new safe harbors in incubation seems like … [Read more...]
FALSE CLAIMS
Pennsylvania M.D. Used Addiction Clinics as Front for Opioid Scheme
August 23, 2019
Case: A 57-year-old doctor pleaded guilty to running an elaborate opioid distribution and insurance fraud scheme out of the Liberation Way addiction treatment center for whom he served as medical … [Read more...]
NEWS
New York Breaks Up $28 Million Medicaid Diagnostics Mill
August 14, 2019
Case: One of the biggest Medicaid diagnostics fraud schemes in recent memory has resulted in multiple convictions, including two doctors and two corporate presidents. According to New York … [Read more...]
