After a recent dip, OIG enforcement activity has seemingly rebounded, at least in terms of total recoveries. That's the basic punchline from the newly published OIG Semiannual Report to Congress … [Read more...]
ENFORCEMENT
Case of the Month: Milwaukee Clinic the Latest MD-Owned Lab Busted for Urine Drug Test Abuses
May 13, 2019
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: April 2019
May 6, 2019
Among the 10 new Work Plan items this month, three may have potential ramifications for at least some labs. Medicaid Managed Care Organization Denials Issue: The State Medicaid agency and the … [Read more...]
OIG
GAO: $77.3 Billion in Improper Medicare/Medicaid 2017 Payments, Including $1.82 Billion to Labs
April 23, 2019
Medicare made $36.2 billion and Medicaid $41.2 billion in improper payments in fiscal year 2017. That's the finding of a report from the Government Accountability Office (GAO) based on CMS estimates … [Read more...]
DRUG TESTING
Enforcement Trends: CMS Looks to Recover $66.3 Million in Improper Specimen Validity Test Payments
April 1, 2019
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...]
ENFORCEMENT
Provider Fined for Not Taking Compliance Measures Required by Its CIA
January 19, 2019
Case: Nearly 10 years ago, a new Affordable Care Act rule requiring labs and other providers to investigate their credit balances for potential Medicare overpayments took effect. In 2015, Pediatric … [Read more...]
CMS
Post-PAMA: Government Report Warns of Medicare Overspending(!) for Lab Tests
December 31, 2018
As if the deep price cuts inflicted by PAMA weren't infuriating enough, now the US Government Accountability Office (GAO) is claiming that labs may be getting overpaid. In a report issued late … [Read more...]
OVERPAYMENTS
Rural Hospital Lab Outreach or Fraudulent Overreach?
November 23, 2018
Case: In February 2017, hospital management firm LifeBrite paid $400K to acquire a bankrupt rural outreach hospital in North Carolina with network status in Blue Cross Blue Shield North Carolina (BC). … [Read more...]
OVERPAYMENTS
CMS to OIG: Get Back the $66.3 Million You Improperly Paid to Labs for Urine Validity Tests
April 10, 2018
As if times were not already tense enough for labs that bill Medicare for urine drug tests, the OIG ratcheted up the pressure another notch on Feb. 20 by issuing a new report chiding CMS for making … [Read more...]
COMPLIANCE
OIG Calls on CMS to Do Better at Medicare Collecting Overpayments
October 24, 2017
The system Medicare uses to detect and recover overpayments isn't working as well as it should be, according to a new OIG report. The Overpayment Collection System CMS relies on special contractors … [Read more...]
