REIMBURSEMENT

Atlanta Medical Group Execs Jailed for $8.5 Million Allergy Testing Scheme

Case: The two owners of now defunct Primera Medical Group pled guilty to criminal charges for their role in billing insurers for allergy blood tests that weren't medically necessary, ordered by a … [Read more...]

COURT CASES

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

New York Breaks Up Massive $28 Million Medicaid Diagnostics Mill Case: One of the biggest Medicaid diagnostics fraud schemes in recent memory has resulted in multiple convictions, including two … [Read more...]

ANTI-KICKBACK

56 Months’ Jail for Lab Technician Caught in Texas Toxicology Scam

Case: A former toxicology testing company account rep pled guilty to conspiring with a medical clinic lab technician to steal patient identities and urine specimens from the clinic and send them to … [Read more...]

NEWS

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

West Virginia Medicaid Recovers $17 Million for $8.5 Million Opioid Scam Case: A subsidiary of Acadia Healthcare Co. has agreed to pay $17 million to settle charges of falsely billing West … [Read more...]

COVERAGE

Medicare Coverage: NGS Testing of Early-Stage Cancer Patients Is Back in Play

The reimbursement outlook for those who provide next generation sequencing (NGS) testing to early-stage cancer of Medicare patients with hereditary risks is far brighter today than it was a few weeks … [Read more...]

FALSE CLAIMS

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

WV Hospital & Marketing Consultant Sued for Elaborate Kickback Scheme Case: A new DOJ lawsuit accuses a West Virginia non-profit hospital and its business consultant of seeking to dominate the … [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...]

REIMBURSEMENT

Kentucky Pain Clinic Pays $127K to Settle Specimen Validity Test Billing Claims

Case: The Northern Kentucky Center for Pain Relief agreed to pay the OIG $126,799.90 to settle claims of billing Medicare for specimen validity testing (SVT). Explanation: Under Medicare rules, urine … [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...]

FALSE CLAIMS

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

56 Months' Jail for Lab Technician Caught in Texas Toxicology Scam  Case: A former toxicology testing company account rep pled guilty to conspiring with a medical clinic lab technician to steal … [Read more...]


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