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...]
COMPLIANCE GUIDANCE
Brief Your CEO: Explain How New DOJ Guidance Can Get Your Lab Out of FCA Hot Water
June 10, 2019
ENFORCEMENT
Compliance Perspectives: Feds Using Medicare Laws to Prosecute Non-Medicare Arrangements
June 3, 2019
Myth: Risk of federal prosecution for health fraud and abuse applies only when you deal with Medicare, TRICARE or other federal health programs. Truth: While that used to be true, the times they are … [Read more...]
COMPLIANCE TIPS
Surviving a Medicare Audit: Warn Lab Staffers Not to Lie to Auditors
May 28, 2019
As a lab compliance director, you understand the dangers of obstructing a Medicare audit. The problem is your staff may not. So, make it clear to any staffer that may come into contact with an auditor … [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...]
ENFORCEMENT
Case of the Month: Milwaukee Clinic the Latest MD-Owned Lab Busted for Urine Drug Test Abuses
May 13, 2019
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
April 29, 2019
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
Mass. Pain Management MDs Jailed for Elaborate Drug Testing Conspiracy
April 26, 2019
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...]
ENFORCEMENT
From Blood Screen to Silver Screen: The Theranos Story Goes Hollywood
April 15, 2019
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
April 1, 2019
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
March 27, 2019
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...]
