Issue: Volume XXVII, No. 14 - October 5, 2020

Lab Finances to Become More Challenging

When you finish reading our story about how Medicare spending for molecular and genetic tests jumped by as much as 700% in certain states during 2019, you’ll be among the first in the nation to understand why a financial crisis is soon to wash over those clinical laboratories and pathology groups that perform genetic tests. We thank Bruce Quinn, …

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Medicare Pays 500% More for Molecular Test Claims

CEO SUMMARY: Rapid growth in what Medicare spent for molecular tests in recent years may lead federal investigators to increase scrutiny of fraudulent billing for clinical laboratory and molecular pathology tests, according to a lab consultant who has tracked such spending in recent years. Data show that Medicare spending for these tests rose sharply since 2017, and that in some Medicare …

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DOJ $6B Fraud Crackdown Charges 345 Defendants

CEO SUMMARY: Department of Justice cases involving clinical labs or molecular test claims may represent about half (or about $3 billion) of the total fraudulent claims. Those claims stem from genetic testing, urine-drug and other tests, and healthcare services, the DOJ said. In addition, the DOJ reported that labs were involved in filing fraudulent claims for lab tests while working with …

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High-Complexity Mobile Labs for COVID-19 Testing

CEO SUMMARY: Demand for high-complexity mobile coronavirus testing facilities is high, according to the CEO of a start-up company building 25 clinical labs in mobile trailers that can do hundreds of tests per eight-hour day. Employers, schools, event organizers, and other entities all have high interest in contracting with this California company for mobile on-site testing that can deliver rapid results …

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LIS and Lab Informatics Vendors Report Second Quarter Earnings

IT’S BEEN A CHALLENGING YEAR for companies that sell laboratory information systems (LIS) to the nation’s clinical laboratories. Because of the SARS-CoV-2 outbreak, labs have delayed decisions to acquire or upgrade their existing LIS systems, as well as previously-scheduled installs of new or upgraded systems. Two major sellers of LIS products in the United States are Cerner Corporation and Roper Technologies’ Sunquest Information Systems. Both …

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UnitedHealth Sets More Billing Rules for Labs, Pathologists

SUBMITTING CLINICAL LABORATORY AND PATHOLOGY TEST CLAIMS to UnitedHealthcare (UHC) will be more complex after the nation’s largest health insurer announced three significant changes in its claims processing procedures. The three changes involve: • Requests for refunds from anatomic pathology (AP) groups that UHC says may have submitted incorrect claims for biopsies, • Rules for out-of-network referrals, and • More tests needing prior …

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October 5, 2020 Intelligence: Late-Breaking Lab News

Guess who will be partnering with the US Department of Veterans Affairs to support its wider use of digital pathology? It’s Google! Last month, it was announced that the Defense Innovation Unit (DIU) of the Department of Defense (DoD) had selected Google Cloud “to prototype an artificial intelligence-enabled digital pathology solution to help detect cancer on multiple disease areas.” This relationship can be expected to encourage acceptance and wider use of digital …

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