CODING

Tennessee Pain Doctor Faces Jail for Opioid Abuses, Medicare Fraud

Case: The doctor is facing 45 charges, including 22 counts of illegal distribution of a controlled substance for routinely prescribing oxycodone and other Schedule II drugs without examining and … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: April 2019

Among the 10 new Work Plan items this month, three may have potential ramifications for at least some labs. Medicaid Managed Care Organization Denials Issue: The State Medicaid agency and the … [Read more...]

ENFORCEMENT

Case of the Month: Another MD-Owned Lab Gets Busted for Urine Drug Test Abuses

Fraudulent utilization and billing of urine drug screening first became a priority for federal enforcers since the $256 million Millennium settlement of 2016. But the opioid crackdown has heightened … [Read more...]

ENFORCEMENT

Mass. Pain Management MDs Jailed for Elaborate Drug Testing Conspiracy

Case: After pleading guilty to running "one of the most dangerous pain management practices in Massachusetts," a medical resident was sentenced to 75 months in jail, three years of supervised release … [Read more...]

REIMBURSEMENT

Kentucky Pain Clinic Pays $127K to Settle Specimen Validity Test Billing Claims

Case: The Northern Kentucky Center for Pain Relief agreed to pay the OIG $126,799.90 to settle claims of billing Medicare for specimen validity testing (SVT). Explanation: Under Medicare rules, urine … [Read more...]

OIG OPINION

Is Your Billing Company Putting You At Compliance Risk?

By Sean McSweeney  bio Does your orthopedic billing company charge a percentage of collections for their coding and billing? They might break out separate charges for statements or other … [Read more...]

WORKING WITH PAYERS

Billing & Coding: Pathology Group Asks CMS to Raise Medicare Prices for BRCA1/2 Sequencing Tests

The Association for Molecular Pathology (AMP) thinks the final 2019 Clinical Laboratory Fee Schedule payment amounts shortchanges labs that provide BRCA genetic testing and is calling on CMS to … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: January 2019

This month, there were six new Work Plan items. The two pertaining to labs are detailed below. The first one has widespread implications for labs; the second may have implications for some labs 1. … [Read more...]

BILLING AND COLLECTIONS

Texas Lab and Owner Get 15-Year Exclusion for Medicare Mileage Swindle

Case: What would you do if your bill for a $43 blood test included a $1,500 travel fee? The patient who actually received such a bill from Texas lab BestCare complained to the government. The … [Read more...]

BILLING AND COLLECTIONS

Aetna Sues Manager of Oklahoma Rural Hospital for Lab Test Ripoff

Case: People's Choice, a management firm specializing in turning around financially strapped hospitals, is being sued by Aetna for using an Oklahoma rural hospital client to carry out an elaborate lab … [Read more...]


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