COVERAGE

Medicare Coverage: NGS Testing of Early-Stage Cancer Patients Is Back in Play

The reimbursement outlook for those who provide next generation sequencing (NGS) testing to early-stage cancer of Medicare patients with hereditary risks is far brighter today than it was a few weeks … [Read more...]

ENFORCEMENT

Case of the Month: Milwaukee Clinic the Latest MD-Owned Lab Busted for Urine Drug Test Abuses

Fraudulent utilization and billing of urine drug screening has become a priority for federal enforcers since the $256 million Millennium settlement of 2016. Subsequent cases have targeted abuses … [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...]

OIG

GAO: $77.3 Billion in Improper Medicare/Medicaid 2017 Payments, Including $1.82 Billion to Labs

Medicare made $36.2 billion and Medicaid $41.2 billion in improper payments in fiscal year 2017. That's the finding of a report from the Government Accountability Office (GAO) based on CMS estimates … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: March 2019

This month, there were 16 new Work Plan items. Three of these may have implications for some labs as detailed below. Medicare Market Shares of Mail Order Diabetes Test Strips Issue: The … [Read more...]

CMS

Brief Your CEO: Notify Your Lab Execs of Upcoming Stark Law Changes

One of the best ways to score points with your lab's executives is to warn them about legal changes before they happen and while there's still time to prepare. And now you have an opportunity to do … [Read more...]

DRUG TESTING

Enforcement Trends: CMS Looks to Recover $66.3 Million in Improper Specimen Validity Test Payments

The opioid crackdown has made urine drug testing an even greater priority for federal health fraud enforcers. One principle target is specimen validity testing (SVT) billed in combination with urine … [Read more...]

CMS

PAMAgeddon: GAO Official Acknowledges Flaws in Lab Price Report as a Powerful Senator Enters the Scene

In November 2018, the U.S. Government Accountability Office (GAO) issued a controversial report suggesting that the new PAMA system will result in billions of dollars worth of Medicare overpayments … [Read more...]

ANTI-KICKBACK

CMS Says Big Changes Are in Store for Stark Law by End of Year

The Stark Law is like the weather: Everybody talks about it but nobody does anything about it. But that all may be about to change if CMS Administrator Seema Verma is to be believed. During her recent … [Read more...]


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