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...]
ENFORCEMENT
Case of the Month: Milwaukee Clinic the Latest MD-Owned Lab Busted for Urine Drug Test Abuses
April 18, 2019
OIG
Medicaid Fraud Enforcement Trends By the Numbers
April 18, 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
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...]
ENFORCEMENT
Pain Clinic Co-Owner Pleads Guilty to Drug Testing Kickback Charges
March 13, 2019
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
March 8, 2019
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
March 4, 2019
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
January 21, 2019
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
January 19, 2019
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...]
