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...]
ANTITRUST
Enforcement Trends: New Emphasis on MD Practices Puts Labs at Growing Risk of Antitrust Enforcement
August 12, 2019
In addition to the usual Medicare and Medicaid anti-fraud laws, labs have a new liability risk to contend with: stepped-up federal and state enforcement of antitrust laws. The driving force behind … [Read more...]
ENFORCEMENT
Focus On: State AGs Break New Ground by Teaming Up to Enforce HIPAA
August 5, 2019
Lab managers and compliance officers take note: For the first time ever, state attorneys general (AGs) have banded together to go after a health care provider for HIPAA violations. Although the … [Read more...]
ENFORCEMENT
Kickbacks: Massachusetts Practice Latest Provider Busted for Taking Kickbacks from Millennium
July 29, 2019
A northern Massachusetts medical practice became the latest downstream provider to pay the OIG a five-figure fine to settle kickback claims in the form of accepting free point-of-care test cups from … [Read more...]
ENFORCEMENT
Compliance Perspectives: Feds Using Medicare Laws to Prosecute Non-Medicare Arrangements
July 28, 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...]
FOCUS ON
State Law Round-up: New Privacy Breach Notification Laws Potentially Affecting Labs
July 28, 2019
As illustrated by the recent MIE settlement (click here for the story), security breaches involving patients' electronic protected health information (ePHI) exposes your lab to liability risks under … [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...]
ENFORCEMENT
Case of the Month: Feds Target Doctors Who Took Kickbacks from HDL
June 28, 2019
When it comes to breaking up lab kickback schemes, federal enforcers start with the lab that paid the kickbacks and then turn to the downstream providers that accepted them. This was the pattern in … [Read more...]
