Case: A new DOJ lawsuit accuses a West Virginia non-profit hospital and its business consultant of seeking to dominate the Ohio Valley market by bribing physicians for referrals. The scheme began in … [Read more...]
ENFORCEMENT
Enforcement Trends: False Claims Act Recoveries Increase as Labs Remain in Firing Line
January 24, 2020
The dollars paid by healthcare providers in federal False Claims Act settlements and judgments increased for the second year in row in 2019. After a surprising decline in 2017, total recoveries … [Read more...]
ENFORCEMENT
Enforcement Trends: The Top 5 Lab False Claims Act Settlements of 2019
January 24, 2020
Labs were on the paying end of at least eight million-dollar False Claims Act (FCA) settlements or judgments in the 2019 fiscal year. Here’s a review of the top 5 reported FCA recoveries against a lab … [Read more...]
ENFORCEMENT
Investment Returns on the Federal Enforcement Dollar Continue to Drop
August 19, 2019
The business of enforcing federal health care fraud laws isn't as robust as it used to be. While revenues have remained pretty steady, return on investment (ROI) has been trending downward, providing … [Read more...]
ENFORCEMENT
Enforcement Trends: Investment Return on Fraud Fighting Continues to Decline
July 22, 2019
Although it's still a profitable endeavor, enforcing federal health care fraud laws isn't providing the investment returns of yesteryears. That's the main takeaway of the new joint HHS and … [Read more...]
COMPLIANCE GUIDANCE
Enforcement Trends: DOJ Changes to Yates Memo Make It Easier for Labs to Get Credit for Cooperating with Investigators
July 1, 2019
For the past five years, the DOJ has followed an enforcement policy designed to hold directors, officers and other top corporate officials responsible for the wrongdoing their companies commit. Last … [Read more...]
DOJ
Compliance Perspectives: Use New DOJ Criteria to Vet the Effectiveness of Your Lab Compliance Program
June 28, 2019
One of the primary responsibilities of a lab manager is to ensure that the lab's compliance program is effective. There's a lot on the line. Having an effective compliance program can help prevent … [Read more...]
COMPLIANCE
DOJ Explains What It Wants from a Compliance Program
June 17, 2019
While it may not prevent all violations, the right compliance program can help your lab get lighter penalties if things go wrong. But what exactly is "the right compliance program." On April 30, the … [Read more...]
COMPLIANCE GUIDANCE
Brief Your CEO: Explain How New DOJ Guidance Can Get Your Lab Out of FCA Hot Water
June 10, 2019
New guidance from the DOJ lays out sheds light on a crucial matter that many high-ranking lab executives are forced to confront: whether to "play ball" with the federal government when internal … [Read more...]
FALSE CLAIMS
Enforcement Trends: Feds Targeting Commercial & Private-Pay, Not Just Medicare Fraud
May 21, 2019
Risk of federal prosecution for health fraud and abuse applies only when you deal with Medicare, TRICARE or other federal health programs. Right? Wrong! While that used to be true, the times they … [Read more...]
