Not surprisingly, the COVID-19 pandemic is hampering federal fraud fighting. The recoveries numbers bear this out. Here are the key findings from the OIG’s new Semi-Annual Report to Congress … [Read more...]
Enforcement Trends
COVID-19 Distractions Cause 2020 OIG Health Care Fraud Recoveries to Dip to 5-Year Low
December 20, 2020
Labs in Court
North Carolina Health System Principles Pay $900K to Settle False Billing Charges
December 10, 2020
Case: The owner and two managers of now defunct Carolina Comprehensive Health Network, PA (CCHN), a group of family medicine practices and pain management services providers in North Carolina, have … [Read more...]
Whistleblowers:
Lab that Ignores Employee’s Billing Concerns Settles FCA Case for $43 Million
November 17, 2020
One of the costliest False Claims Act settlements involving lab tests in recent years is still one more cautionary tale of how dismissing the reports of lab employees who come forward to express … [Read more...]
Labs In Court
Out-of-Network Drug Testing Labs Can Sue UnitedHealthcare for Inadequate Reimbursement
November 13, 2020
Case: A group of out of network labs and substance abuse clinics sued UnitedHealthcare for reimbursing them only 19.5% of covered charges on 1,306 insureds that had already met their annual … [Read more...]
Labs in Court
Michigan Reference Lab Settles False Billing Charges for $1.2 Million
October 29, 2020
Case: The OIG claimed that Michigan reference lab Great Lakes Medical Laboratory, Inc. ripped off Medicare and United Mine Workers Association (UMWA) health plans by billing for routine urine and … [Read more...]
Enforcement Trends
Whistleblowing Activity Continues to Grow Despite the Pandemic
October 22, 2020
Even during a pandemic, False Claims Act whistleblower litigation against labs and other health providers continues to be a highly profitable business for both whistleblowers and the federal … [Read more...]
Whistleblowers
Relying on the First-to-File Rule to Protect You from Copycat Qui Tam Lawsuits
October 13, 2020
As you know, the private individuals, known as relators, the right to bring qui tam lawsuits on the government’s behalf against labs and other contractors that submit false claims to the federal … [Read more...]
Labs In Court
A roundup of recent cases and enforcement actions involving the diagnostics industry
October 8, 2020
Referral Arrangement Violates Kickback Laws Even If Even Only Purpose Is to Generate Illegal Referrals Case: The U.S. Attorney accused a Kentucky physician of taking a $105 per beneficiary payment … [Read more...]
Labs in Court
Referral Arrangement Violates Kickback Laws Even If Only Purpose Is to Generate Illegal Referrals
September 28, 2020
Case: The U.S. Attorney accused a Kentucky physician of taking a $105 per beneficiary payment from a lab company in exchange for ordering its pharmacogenetic tests in violation of the Anti-Kickback … [Read more...]
Whistleblowers
California Case Shows Why Paying Specimen Collection Fees of Any Amount Are a Liability Risk
September 17, 2020
Paying physicians fees to collect and process patient samples for testing is a dicey proposition because it exposes labs to suspicion under the Stark and Anti-Kickback Statute laws. Such arrangements … [Read more...]
