A roundup of recent cases and enforcement actions involving the diagnostics industry Lab’s ‘False Positive’ Drug Test Report ≠ Defamation of Employee Case: An Arkansas nurse got fired … [Read more...]
CMS
Lab Fails in Bid to Get Medicare Payment Suspension Set Aside
November 6, 2019
Case: In 2017, CMS suspended 100% of Medicare payments to True Health Diagnostics (THD) based on what it called “credible allegations of fraud.” Two years later, while the suspension was still in … [Read more...]
FALSE CLAIMS
Federal Court Dismisses Urine Drug Test False Billing Claim
October 30, 2019
Case: Whistleblowers accused a national lab company of falsely billing Medicare and Medicaid for high complexity quantitative urine drug tests under CPT code G0431 at up to $476 per test. According to … [Read more...]
ENFORCEMENT
Enforcement Trends: New Takedown Is Evidence that Genetic Testing Has Become an Enforcement Priority
October 29, 2019
It’s a pretty good sign that fraudulent billing of genetic lab testing has become a priority for federal fraud enforcers when it gets its very own “takedown.” Known as Operation Double Helix, the … [Read more...]
Labs In Court
October 28, 2019
A roundup of recent cases and enforcement actions involving the diagnostics industry ACLA Goes for Knockout Punch in PAMA Lawsuit Case: Having survived a first-round setback, the American … [Read more...]
ANTI-KICKBACK
Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry
October 18, 2019
Quest Pays $88.7K to Settle Specimen Collection Fee Kickback Charges Against Its Subsidiary Case: After self-disclosing, Quest has settled kickback claims against its wholly-owned subsidiary, … [Read more...]
ANTI-KICKBACK
WV Hospital & Marketing Consultant Sued for Elaborate Kickback Scheme
September 27, 2019
Case: A new DOJ lawsuit accuses a West Virginia non-profit hospital and its business consultant of seeking to dominate the Ohio Valley market by bribing physicians for referrals. The scheme began in … [Read more...]
ENFORCEMENT
West Virginia Medicaid Recovers $17 Million for $8.5 Million Opioid Scam
September 19, 2019
Case: A subsidiary of Acadia Healthcare Co. has agreed to pay $17 million to settle charges of falsely billing West Virginia Medicaid for opioid-related tests. The DOJ claims that over a six-year … [Read more...]
CODING
Urgent Care Centers Settle E/M Upcoding Charges for $2 Million
September 11, 2019
Case: The owners/operators of CareWell urgent care centers in Massachusetts and Rhode Island have agreed to shell out $2 million for improper coding of Evaluation and Management services. CPT code … [Read more...]
COMPLIANCE
Genetic Testing Fraud Prosecutions are on the Rise around the Country. Are Your Genetic Testing Practices Compliant?
September 10, 2019
By Robert Liles bio Over the last year, a number of genetic testing fraud investigations and prosecutions have been initiated by Medicare, Medicaid and TRICARE investigators and auditors. While the … [Read more...]
