Since 1995, Reliable Business Intelligence for Clinical Laboratories, Pathology Groups and Laboratory Diagnostics

December 2010

Any Future for Loss-Leader Lab Pricing?

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

OUTSIDE OF CALIFORNIA, few pathologists or laboratory administrators are aware of the unfolding enforcement campaign that was initiated by the state’s Medi-Cal program. At issue is a decades-long practice of offering providers low laboratory test prices—in some cases well below the Medi-Cal fee schedule. You may say, “what’s the big deal?”, since, for years, you’ve seen […]

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Discounted Lab Prices Become Issue in California

Laboratory Compliance / Robert Michel

CEO SUMMARY: For decades, California’s lab testing market has been considered the Wild West because clinical lab companies have felt relatively free to offer deeply-discounted prices to expand market share and take business away from competitors. Now these discounted pricing practices are being scrutinized by no less than three government bodies. First came a whistleblower

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Medi-Cal Gets Tough on Low Lab Test Prices

Laboratory Compliance / Robert Michel

CEO SUMMARY: This may be the most significant lab industry story of 2010, which has gone unreported until now. Starting in June and July, California’s Department of Health Care Services determined that between 10 and 30 labs had submitted what the agency considers to be false claims. It sent out letters to these labs to

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Who Wins and Who Loses With 51501 Enforcement

Laboratory Compliance / Robert Michel

CEO SUMMARY: Assume that California’s Department of Health Care Services (DHCS) wins all challenges to enforcement of its interpretation of 51501(a). DHCS will get a one-time cash infusion as it collects money from labs which violated the state statute. But going forward, federally qualified health centers, independent practice associations, private payers, and patients will pay

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How Could So Many Labs Violate California Law?

Laboratory Compliance / Robert Michel

CEO SUMMARY: If a 40-year-old state law on Medi-Cal pricing was known to regulators and clinical laboratories alike, how did the legal and compliance departments of so many laboratories—staffed by some of the smartest legal minds in California and nationally—interpret the law in such a different way as the state’s primary laboratory regulator? After all,

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Calif. Officials Back Off From Suspending Labs

Laboratory Compliance / Joseph Burns

CEO SUMMARY: Early in the summer, California’s Department of Health Care Services (DHCS) delivered letters to between 10 and 30 laboratory companies notifying them that, effective immediately, it was withholding their Medi-Cal payments and was suspending each lab’s Medi-Cal license. However, the intense reaction triggered by this unexpected and unequal enforcement campaign apparently caused DHCS

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Did Qui Tam Suit Trigger Medi-Cal Price Concerns?

Laboratory Compliance / Robert Michel

CEO SUMMARY: It is easy to track backwards to understand why the California Department of Healthcare Services (DHCS) began aggressive enforcement of its interpretation of statute 51501(a) against a number of labs this summer. DHCS officials were given a full education and a roadmap for action when, in April, 2009, the whistleblower lawsuit that accused

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December 27, 2010 “Intelligence: Late Breaking Lab News”

Late Breaking Lab News / Robert Michel

As the year ends, a bit of humor is in order and the recent dust-up involving Michael Moore’s healthcare documentary, titled “Sicko,” and a State Department cable posted on wikileaks.com may be just the item. About a week ago, The Guardian newspaper in Manchester, England, reported that a State Department cable posted on wikileaks.com had

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Reading the Tea Leaves from 2010’s Events

Commentary and Opinion by R. Lewis Dark / R. Lewis Dark

EACH YEAR WHEN WE PRESENT OUR “Top Ten Lab Stories” for the year, I am always surprised at which forces for change emerged during the prior 12 months. In presenting THE DARK REPORT’S “Top Ten Lab Stories for 2010,” our editor has pointed out that four of these ten stories involved the federal government in

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Our Top Ten Lab Stories Highlight Major Changes

Clinical Laboratory Trends / Robert Michel

CEO SUMMARY: What makes 2010 a watershed year for the laboratory testing industry is enactment of the 2,700-page Patient Protection and Affordable Care Act (PPACA). Even if parts of this bill are repealed, the remaining parts of the massive legislation will trigger major changes to the healthcare system as it operates today. Other stories in

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