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November 2019

Is New Medicare Affiliation Rule Good, Bad, or Ugly?

Commentary and Opinion by R. Lewis Dark / By

THERE IS AN OFT-REPEATED ADAGE THAT what the government gives you with one hand, it takes away with the other. This may be an apt description of the new Medicare final rule that takes effect today, called the Program Integrity Enhancements to the Provider Enrollment Process (CMS-6058-FC). The goal of the new rule is to …

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Medicare Affiliation Rule Targets Criminal Behavior

Laboratory Compliance / By

CEO SUMMARY: Under a new federal rule in effect this month, all healthcare providers—including clinical laboratories and pathology groups—will need to scour the records of all officers, directors, and affiliates to identify any that have had negative dealings with CMS or other federal enforcement agencies. Under the rule, the Medicare program is likely to target …

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Labs Need to Act on New Medicare Enrollment Rules

Laboratory Management / By

CEO SUMMARY: For all healthcare providers—including clinical laboratories and pathology groups—a new rule became effective this month. The rule allows Medicare to revoke or deny enrollment if a provider or supplier’s affiliates pose an undue risk of fraud. Lawyers familiar with the “Program Integrity Enhancements to the Provider Enrollment Process” rule are concerned about its …

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How Labs Can Add Value for Providers, Insurers, Pharma

Laboratory Management / By

CEO SUMMARY: For pathologists and clinical, molecular, and genetic testing labs, appropriate reuses of lab data can provide a new source of revenue. Labs that serve as preferred providers of diagnostic testing data can help health systems, ordering physicians, pharmaceutical companies, and other organizations when they reuse lab test data to support evidence-based care and …

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UTC Labs to Pay $41.6 Million in a Civil Settlement With DOJ

Laboratory Compliance / By

ONE MORE LAB COMPANY has settled allegations of fraud and abuse. Last month, UTC Laboratories agreed to pay a fine of $41.6 million and will be excluded from all federal healthcare programs for 25 years. Announced Oct. 9, the settlement resolves allegations that UTC violated the False Claims Act by paying kickbacks in exchange for …

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Health Insurers Spending Billions to Diversify

Clinical Laboratory / By

CEO SUMMARY: One big development affecting the health insurance business is how four of the nation’s largest health insurers are diversifying in significant ways. Last spring, a healthcare strategist explained how each of these companies has spent billions of dollars in recent years to acquire other healthcare companies that are not part of the traditional …

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November 4, 2019 Intelligence: Late Breaking Lab News

Late Breaking Lab News / By

Pharmacogenetic testing is gaining acceptance by a growing number of health insurers. On Oct. 1, UnitedHealthcare (UHC) began coverage of genetic tests that help physicians identify the anti-depressant drugs most likely to benefit their patients. UHC’s policy also extends coverage to multi-gene testing for antipsychotic drugs. In writing about this decision, www.clinicalomics.com said, “UnitedHealthcare’s policy …

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CMS Affiliation Rule Targets Medicare Fraud Cases

TDR Insider / By

This is an excerpt of a 2,027-word article in the Nov. 4, 2019 issue of THE DARK REPORT (TDR). The full article is available to members of The Dark Intelligence Group.  CEO SUMMARY: Under a new federal rule in effect this month, all healthcare providers—including clinical laboratories and pathology groups—will need to scour the records …

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