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

Lab Finances to Become More Challenging

When you finish reading our story about how MedicareĀ spending for molecular and genetic tests jumped by as much as 700% in certainĀ states during 2019, you’ll be among the first in the nation to understand whyĀ a financial crisis is soon to wash over those clinical laboratories and pathologyĀ 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 forĀ molecular tests in recent years may lead federal investigatorsĀ to increase scrutiny of fraudulent billing for clinical laboratoryĀ and molecular pathology tests, according to a lab consultantĀ who has tracked such spending in recent years. Data show thatĀ Medicare spending for these tests rose sharply since 2017, andĀ that in some Medicare …

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DOJ $6B Fraud Crackdown Charges 345 Defendants

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

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High-Complexity Mobile Labs for COVID-19 Testing

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

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LIS and Lab Informatics Vendors Report Second Quarter Earnings

IT’S BEEN A CHALLENGING YEAR forĀ companies that sell laboratory informationĀ systems (LIS) to the nation’s clinicalĀ laboratories. Because of the SARS-CoV-2Ā outbreak, labs have delayed decisionsĀ to acquire or upgrade their existing LISĀ systems, as well as previously-scheduledĀ installs of new or upgraded systems. Two major sellers of LIS products inĀ the United States are Cerner CorporationĀ and Roper Technologies’ SunquestĀ Information Systems. Both …

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UnitedHealth Sets More Billing Rules for Labs, Pathologists

SUBMITTING CLINICAL LABORATORY AND PATHOLOGY TEST CLAIMS toĀ UnitedHealthcare (UHC) will beĀ more complex after the nation’s largestĀ health insurer announced three significantĀ changes in its claims processingĀ procedures. The three changes involve: • Requests for refunds from anatomicĀ pathology (AP) groups that UHC saysĀ may have submitted incorrect claimsĀ 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 beĀ partnering with theĀ US Department ofĀ Veterans Affairs to supportĀ its wider use of digitalĀ pathology? It’s Google! LastĀ month, it was announced thatĀ the Defense Innovation UnitĀ (DIU) of the Department ofĀ Defense (DoD) had selectedĀ Google Cloud ā€œto prototypeĀ an artificial intelligence-enabledĀ digital pathology solutionĀ to help detect cancer onĀ multiple disease areas.ā€ ThisĀ relationship can be expectedĀ to encourage acceptance andĀ wider use of digital …

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