CODING

Urgent Care Centers Settle E/M Upcoding Charges for $2 Million

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?

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

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

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

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

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

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

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

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

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...]


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