SELF-DISCLOSURE

Compliance Perspectives: How the New OIG Fraud Risk Indicator System Heightens the Imperative of Self-Disclosure

As hard as you try to keep your lab 100% compliant with healthcare fraud and abuse laws, you may discover that an inadvertent violation has occurred. At that point, the compliance imperative switches … [Read more...]

ENFORCEMENT

Case of the Month: Milwaukee Clinic the Latest MD-Owned Lab Busted for Urine Drug Test Abuses

Fraudulent utilization and billing of urine drug screening has become a priority for federal enforcers since the $256 million Millennium settlement of 2016. Subsequent cases have targeted abuses … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: March 2019

This month, there were 16 new Work Plan items. Three of these may have implications for some labs as detailed below. Medicare Market Shares of Mail Order Diabetes Test Strips Issue: The … [Read more...]

DRUG TESTING

Enforcement Trends: CMS Looks to Recover $66.3 Million in Improper Specimen Validity Test Payments

The opioid crackdown has made urine drug testing an even greater priority for federal health fraud enforcers. One principle target is specimen validity testing (SVT) billed in combination with urine … [Read more...]

OIG OPINION

Is Your Billing Company Putting You At Compliance Risk?

By Sean McSweeney  bio Does your orthopedic billing company charge a percentage of collections for their coding and billing? They might break out separate charges for statements or other … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: February 2019

This month, there were two new Work Plan items. One of these may have implications for some labs and is detailed below. Characteristics of Part D Beneficiaries at Serious Risk of Opioid Misuse or … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: January 2019

This month, there were six new Work Plan items. The two pertaining to labs are detailed below. The first one has widespread implications for labs; the second may have implications for some labs 1. … [Read more...]

UTILIZATION MANAGEMENT

You Make the Call: Incentivizing MDs to Order More Early Screening Tests

A Managed Care Organization (MCO) wants to pay providers incentives to increase early and periodic screenings, diagnostic and treatment (EPSDT) services to Medicaid patients. Payments are capitated, … [Read more...]

Enforcement Trends: Opioid Crackdown Is Diverting Resources from Traditional OIG Enforcement Activities

The OIG won't admit it, but the opioid crackdown is diverting resources from traditional Medicare fraud and waste enforcement efforts. At least that's the most likely explanation for the dramatic … [Read more...]

COMPLIANCE PLANS

OIG Monthly Work Plan Review: November 2018

This month, there were six new Work Plan items, two of which have implications for at least some labs. 1. CDC's Oversight of the President's Emergency Plan for AIDS Relief Funds Issue: Through the … [Read more...]


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