REIMBURSEMENT

Medicare Reimbursement: MIPS Bonuses Are Easy to Earn, IF You Can Get into the Program

On July 11, CMS announced the results of 2018, Year 2 under the Merit-based Incentive Payment System (MIPS). Bottom line: The total number of clinicians participating declined from 1.06 million to … [Read more...]

NEWS

New York Breaks Up $28 Million Medicaid Diagnostics Mill

Case: One of the biggest Medicaid diagnostics fraud schemes in recent memory has resulted in multiple convictions, including two doctors and two corporate presidents. According to New York … [Read more...]

ANTI-KICKBACK

Maryland Hospital Fined $457.2K for Free Support Services Kickbacks

Case: Union Hospital of Cecil County, Inc. has agreed to pay $457,213 for a pair of self-disclosed kickback violations, namely, paying remuneration to: Physicians in the form of free support … [Read more...]

FALSE CLAIMS

Kentucky Lab Pays $125K to Settle Self-Disclosed SVT False Billing Charges

Case: VerraLab JA, LLC, has agreed to pay $125,983 after self-disclosing that it billed Medicare for specimen validity tests (SVT) performed to authenticate urine samples for drug testing. Unlike the … [Read more...]

WHISTLEBLOWERS

Billing & Coding: Myriad Genetics Pays $9.1 Million to Settle Claims of Falsely Billing Medicare for Hereditary Cancer Tests

In March 2018, Myriad Genetics got a piece of mail no lab provider ever wants to see in its inbox: an OIG subpoena asking for billing records in connection with "an investigation into possible false … [Read more...]

HEALTH CARE REFORM

Developing Story: Doubt Grows as Obamacare Court War Enters Round 2

Heartburn over the survival of Obamacare is back with a vengeance. It reawakened seven months ago, after a Texas U.S. District Court found The Affordable Care Act unconstitutional—not just the … [Read more...]

COURT CASES

Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry

Drug Abuse Treatment Owner Guilty of $57 Million Drug Test Pass-Thru Billing Conspiracy Case: The owner of a northern Florida substance abuse treatment center pleaded guilty for his role in a … [Read more...]

NEWS

Healthcare ‘Trial of the Century’ Ends in Guilty Verdict against Esformes

Case: After a seven-week trial, a federal court convicted Florida healthcare executive Philip Esformes of 20 charges in carrying out a $1.3 billion Medicare fraud scheme, the biggest in history. In … [Read more...]

INDUSTRY BUZZ

FDA Watch: First Zika Assay Gets Green Light for Marketing

Over the past several years, the FDA has issued Emergency Use Authorization (EUA) for over a dozen different tests for Zika. But on May 23, 2019, the FDA did something it had never done before: It … [Read more...]

FALSE CLAIMS

Florida Providers Shell Out $733K+ for Self-Disclosed Lab Test Kickbacks

Case: The OIG entered into separate settlement agreements with the three providers involved in a self-disclosed kickback arrangement. Although the details weren't disclosed, Orlando Foot & Ankle … [Read more...]


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