Owner of MD Practices Settles Fraud Charges for $3.07 Million Case: Individual physicians implicated in frauds committed by the practices and clinics they own is this month's predominant theme. … [Read more...]
COURT CASES
Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry
December 14, 2018
COMPLIANCE GUIDANCE
Compliance Perspectives: Avoid Kickback Liability by Steering Clear of MD Processing Fees
December 10, 2018
Editor's Note: Two months ago, we talked about paying referring physicians a fee for collecting and processing blood, urine, tissue and other specimens. (G2 Compliance Advisor, Oct. 9, 2018, p. 1). … [Read more...]
ENFORCEMENT
Feds Continue Roundup of Physicians on Receiving End of Millennium Labs Test Cups Freebie
December 3, 2018
The Millennium Laboratories free point of care test (POCT) cups scandal has been described as the biggest kickback scandal involving lab services in history. And its legacy has now entered a new … [Read more...]
CONSUMER FRAUD
Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry
November 28, 2018
New York Doctor Busted for Falsely Billing Medicaid for Lab Drug Tests Case: The State claims that the physician billed for $939,000 worth of drug testing services that his lab didn't and … [Read more...]
PAMA
Medicare Reimbursement: CMS Offers Some PAMA Relief But Not Nearly Enough
November 28, 2018
The final 2019 Clinical Laboratory Fee Schedule (CLFS) (Final Rule) is out and it's just as bad as last year's. Here's a rundown of what lab compliance and reimbursement managers need to know. CMS's … [Read more...]
FOCUS ON
Medicare Reimbursement: 2019 CLFS Offers Some PAMA Relief But Not Nearly Enough
November 19, 2018
The battle between CMS and the lab industry over Medicare Part B pricing for lab tests is intensifying notwithstanding the ACLA's recent court loss and the supposed relief offered by the agency in its … [Read more...]
FEE SCHEDULES
Reimbursement Trends: Part B Medicare Lab Payments Up Slightly in 2017
November 19, 2018
According to a new OIG report, Clinical Laboratory Fee Schedule payments for lab tests in 2017, the last year under the pre-PAMA payment system, totaled $7.1 billion, up slightly from the $6.8 billion … [Read more...]
REIMBURSEMENT
MACRA: QPP Year 1 By the Numbers
November 16, 2018
On Nov. 8, CMS posted Merit-based Incentive Payment System (MIPS) performance results for 2017, the first year of the Quality Payment Program (QPP) which it will use to determine 2019 Medicare … [Read more...]
COURT CASES
Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry
November 16, 2018
Abbott Pays $25 Million to Settle TriCor Kickback & Off-Label Marketing Claims Case: The case began when a sales rep accused Abbott Laboratories and AbbVie Inc. of paying kickbacks to induce or … [Read more...]
PAMA
Medicare Reimbursement: Part B Lab Payments in Final Year before PAMA
November 5, 2018
Part B payments for lab tests in 2017, the final year under the old reimbursement rules, totaled $7.1 billion, up slightly from the $6.8 billion Medicare paid in 2016 and little changed over the … [Read more...]
