Labs in Court

Drug Abuse Treatment Owner Guilty of $57 Million Drug Test Pass-Thru Billing Conspiracy

Case: The owner of a northern Florida substance abuse treatment center pleaded guilty for his role in a $57 million pass-through lab testing billing and money laundering scheme. The way it worked: The … [Read more...]

Billing & Collections

Finding the “Backdoor” into Payer Networks

By Steve Selbst bio  I am delighted to be able to share with you a key “secret to success” about payer contracting. Today’s article is about getting in the “backdoor” with payers and complementing … [Read more...]

Labs In Court

Lab Uses Billing Info of Another Lab to Get Around Payment Restrictions

Case: In 2015, Kentucky Medicaid and private payors began having doubts about the legitimacy of urine drug test claims submitted by CAL Laboratory Services and restricted payments to the toxicology … [Read more...]

BILLING & COLLECTIONS

Accessions Disappearing or Not Getting Billed?

By Sean McSweeney bio Ever get that feeling that there should be more charges in the billing system? How many times have you or someone else said something like “we did 3000 samples last month, but … [Read more...]

LABS IN COURT

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...]

BILLING & COLLECTIONS

5 ways to break down bureaucracies to get payer contracts

By Steve Selbst bio It is important to remember that payers are large companies, with protocols, policies and business practices. As with any large company, there are bureaucracies, and they are … [Read more...]

ANTI-KICKBACK

Alabama Doctors, Cardio Practice, Settle Genetic Testing Kickback Claims for $1.1 Million 

Case: Three doctors and a cardiology practice, all based in Alabama, have agreed to shell out $1.1 million for allegedly taking bribes from a now-bankrupt genetic testing company in the Seattle area. … [Read more...]

LABS IN COURT

Feds Take Down Florida Substance Abuse Clinic Principles for Drug Test Fraud

Case: A trio of individuals associated with a Miami substance abuse facility were charged with taking part in a scheme to bill private insurers for tests that weren’t medically necessary or, in some … [Read more...]

Labs In Court

A roundup of recent cases and enforcement actions involving the diagnostics industry   Lab’s ‘False Positive’ Drug Test Report ≠ Defamation of Employee  Case: An Arkansas nurse got fired … [Read more...]

FALSE CLAIMS

Federal Court Dismisses Urine Drug Test False Billing Claim

Case: Whistleblowers accused a national lab company of falsely billing Medicare and Medicaid for high complexity quantitative urine drug tests under CPT code G0431 at up to $476 per test. According to … [Read more...]


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