FALSE CLAIMS

Florida Doctor Jailed 5 Months for Lying to a Medicare Auditor

Lying to a Medicare auditor or otherwise obstructing a Medicare audit is a crime that can get you jailed. A 73-year-old endocrinologist specializing in diabetes management just learned that lesson the … [Read more...]

ANTI-KICKBACK

Enforcement Trends: Feds Administer a Double Dose of Civil Monetary Penalty Increases

Potential penalties for Medicare violations will be higher if they're assessed on or after Oct. 11, 2018. That's when the newly announced Dept. of Health and Human Services' (HHS) inflation-adjusted … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: October 2018

October saw five new OIG Work Plan items. One has direct implications for labs, while two have potential implications for some labs. These three items are detailed below. 1. CMS Medicare Beneficiary … [Read more...]

FEE SCHEDULES

Medicare Reimbursement: Labs Propose Solutions to PAMA Part B Pricing Problem

CMS recently issued its annual proposed rule on 2019 Medicare Part B reimbursement. For many labs, the number one concern is the proposed extension of the controversial PAMA "market pricing" scheme to … [Read more...]

FALSE CLAIMS

PAMA: ACLA Loses Court Lab Fees Battle But May Still Win Regulatory War

It was a long shot to begin with. But that doesn't ease the disappointment of what happened in a Washington, DC courtroom when a federal judge tossed a lab industry lawsuit challenging the legality of … [Read more...]

CMS

Reimbursement Trends: OIG Report Shows Slight Uptick in 2017 Medicare Part B Lab Payments

On Jan. 1, 2018, the new Medicare Part B PAMA Clinical Laboratory Fee Schedule (CLFS) in which lab test reimbursements are based on a single national fee lab schedule for lab tests rather than 57 … [Read more...]

STARK LAW

Stark Relief: Comments Urge Change but Don’t Expect Anything Too Dramatic

After decades of resistance, CMS is giving serious indications of its willingness to entertain changes to relieve the "undue regulatory impact and burden" imposed by the Stark Law. Back in June, CMS … [Read more...]

HEALTH CARE REFORM

Health Insurance Market: Two Recent Changes & Their Impact on Labs

Amid all the talk of sweeping reform of the health insurance marketplace, the smaller, interim changes get overlooked despite their direct impact on labs and other providers. Two such changes took … [Read more...]

COMPLIANCE CORNER

Stark Relief: Change Seems Imminent but Less Dramatic than Industry Wants

CMS is giving serious indications of its willingness to entertain Stark Law relief. Back in June, CMS issued a Request for Information (RFI) seeking public comments and suggestions on changes to … [Read more...]

HEALTH CARE REFORM

Medicare Reimbursement: How CMS Price Transparency Proposal Could Hurt Labs & Patient Relations

Last April, CMS issued a proposed rule to make Medicare rates more transparent. While designed to "empower patients and reduce administrative burden," the proposed changes would literally come at a … [Read more...]


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