For more than a decade, enforcement of the federal false claims act was a government cash cow. But in recent years, investment returns on the activity actually declined. That trend came to an end last … [Read more...]
Kickbacks
OIG Sheds Light on When Price Reductions Must Meet Discounts Safe Harbor
August 23, 2021
Labs that offer discounts of any kind to referring physicians run the risk of liability under the Anti-Kickback Statute (AKS) and other federal laws. However, new OIG Advisory Opinion No. 21-06 gives … [Read more...]
Enforcement
Fraud Recoveries Grow as Feds Target Telemedicine and COVID-19 Add-On Test Scams
July 29, 2021
Despite the COVID-19 pandemic and continued sequestration of enforcement funds, the federal Health Care Fraud and Abuse Control Program (Program) reversed recent trends and recovered more money in FY … [Read more...]
BILLING
OIG Work Plan Targets Medicare Part B Billing & Payment of Lab Tests
June 28, 2021
During the Public Health Emergency (PHE), the Department of Health and Human Services (HHS) has cut labs extraordinary slack in the form of waivers that temporarily loosen Medicare test coverage rules … [Read more...]
Billing and Coding
OIG Calls on CMS to Crack Down on Improper Payment of Definitive Drug and LDL Cholesterol Tests
June 28, 2021
History tells us that whenever OIG issues a report pointing out a pattern of Medicare Part B overpayments for lab tests, labs and physicians that provide those tests should be concerned. In recent … [Read more...]
Billing & Coding
OIG Sounds the Alarm on Improper Billing of Lipid Panels & Direct HDL Tests
May 24, 2021
Medicare could and should have saved over $20 million in payments for medically unnecessary LDL cholesterol blood tests if CMS hadn’t been asleep at the wheel for the past five years. That’s the gist … [Read more...]
Reimbursement
OIG Sounds the Warning on Improper COVID-19 Vaccination Billing
May 10, 2021
Labs and providers that furnish COVID-19 testing and vaccination services need to look ahead and prepare for the massive federal false billing crackdown that is sure to come if and when the pandemic … [Read more...]
Billing & Collections
OIG Targets Pandemic’s Impact on Billing of Medicare Part B Lab Testing
February 22, 2021
Looking upon Medicare billing and payment of lab services with suspicion is and has always been part of the OIG’s organizational DNA. So, the fact that audits of Medicare Part B lab services during … [Read more...]
Enforcement Alert
OIG to Audit Medicare Part B Lab Testing During the Pandemic
February 20, 2021
Fraudulent and abusive billing of lab services has long been a favorite target of OIG enforcers. And with the unprecedented surge of COVID-19 testing during the public health emergency, it’s hardly … [Read more...]
Consumer Fraud
OIG Warns Medicare Beneficiaries Not to Fall for COVID-19 Scams
January 6, 2021
Pharma companies, diagnostics manufacturers, labs and other parts of the healthcare industry have done a commendable job in pivoting in response to the current public health industry. Sadly, it seems … [Read more...]
