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...]

OIG

Medicaid Fraud Enforcement Trends By the Numbers

A new report from OIG details Medicare Fraud Control Unit (MCFU) enforcement activity in fiscal year 2018. Bottom Line on Top: The numbers were pretty consistent with previous trends with little in … [Read more...]

ENFORCEMENT

From Blood Screen to Silver Screen: The Theranos Story Goes Hollywood

Clinical labs are not usually the stuff of Hollywood. But the story of Theranos and its charismatic leader has attracted filmmakers the way regular law-abiding labs never do, spawning not one but a … [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...]

DRUG TESTING

Enforcement Trends: CMS Orders Medicare Contractors to Go After Labs that Received Specimen Validity Test Payments

Reflecting the wider opioid crackdown, CMS is targeting labs that perform urine drug testing for potential billing abuses. The hottest initiative: Labs that bill specimen validity testing (SVT) in … [Read more...]

ENFORCEMENT

Pain Clinic Co-Owner Pleads Guilty to Drug Testing Kickback Charges

Case: The Louisiana physician received $336,000 in kickbacks from a drug testing lab representing a percentage of the reimbursement proceeds generated via the referrals of Medicare patients' urine … [Read more...]

ENFORCEMENT

Owner of MD Practices Settles Fraud Charges for $3.07 Million

Case: Individual physicians implicated in frauds committed by the practices and clinics they own is a predominant theme in recent cases. Leading off is the MD owner of a pair of medical practices in … [Read more...]

HIPAA

Enforcement Trends: Record Breaking Year for HIPAA Fines

The federal Office for Civil Rights (OCR) reports that 2018 was a record year for HIPAA enforcement, with 10 settlements and one judgment bringing in $28.7 million in fines, easily surpassing the old … [Read more...]

COMPLIANCE

Enforcement Trends: After 2017 Decline, False Claims Act Healthcare Recoveries Bounce Back

Although the False Claims Act (FCA) remains a federal enforcement cash cow, the growth rate has fallen off in recent years, at least in the healthcare sector. But that short-term trend could be in … [Read more...]

ENFORCEMENT

Provider Fined for Not Taking Compliance Measures Required by Its CIA

Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]


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