Enforcement Trends

COVID-19 Distractions Cause 2020 OIG Health Care Fraud Recoveries to Dip to 5-Year Low

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...]

Labs in Court

North Carolina Health System Principles Pay $900K to Settle False Billing Charges

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

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

 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

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

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

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

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

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

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...]


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