The most complete archive of clinical and pathology lab industry news available, including issues from 1997 to the present.
THE DARK REPORT digs into the shocking path lab deficiencies found at Wake Forest Baptist Medical Center and discovers that labs with a single individual with critical compliance, training and oversight responsibilities could leave them in the same dangerous position. Also, analysis in this issue helps lab executives understand the issues in the PAMA lawsuit against HHS to better prepare them to educate their elected officials.
HERE’S A FIRST LOOK at an important new trend: At first, it probably will have the greatest impact on anatomic pathology groups that perform cancer tests. But even clinical labs will find themselves dealing with new factors in the lab testing marketplace—particularly the ability to access or license valuable assays that incorporate the latest diagnostic technologies. Also in this issue are the latest developments in the tale of a lab company that made an early splash in drugs-of-abuse and pain management testing almost two decades ago, but is now going out of business, in part due to lingering allegations of abusive sales and billing practices.
THE DARK REPORT WAS THE FIRST to draw attention to the increasingly popular “HOPD” billing scheme last November. Now it digs deeply into the details of new case that offers confirmation that insurers are resisting such schemes, as Anthem is poised to sue a tiny California hospital if it does not recover $13.5 million in a timely fashion. Also, TDR gives an exclusive analysis of documents in the PAMA lawsuit filed against CMS — including the revelation that CMS appears to have deliberately calculated how much Medicare could save by ignoring certain data, instead of basing the new fees on all the data requested by Congress.
AN EXCLUSIVE ANALYSIS of the HDL-BlueWave fraud trial has several lessons for laboratorians: There’s new personal exposure that individuals may face from the federal government, a jury trial will not necessarily save wrongdoers, and blaming bad legal advice is a losing strategy if you’re thinking of breaking the rules. And in a related issue, experts in lab compliance predict that clinical labs and anatomic pathology groups must anticipate tougher enforcement of federal and state laws this year, starting with the rising use of third-party marketing agreements.
AFTER A YEAR-LONG INVESTIGATION, THE DARK REPORT has put together evidence of an almost decade-long string of legal proceedings involving the healthcare businesses organized by some of the defendants in one of last year’s big fraud lawsuits. One year ago, UnitedHealth made national news when it filed a $100M lawsuit against Next Health and other defendants in Dallas. In the suit, UHC says the defendants submitted lab test claims totaling $400M between 2011 and 2016, and that it made payments of $101.5M to the defendant companies. Now TDR explains the serial nature of other lawsuits, federal indictments, and whistleblower cases involving some of these same defendants over the years.
WHAT ARE THE ODDS for or against ACLA’s lawsuit against the Department of Health and Human Services? THE DARK REPORT has exclusive insight from two experienced lab industry attorneys to help lab managers better understand the likely paths that this litigation may take, and know how long it may take to come to a conclusion. Also, TDR is the first to alert readers that UnitedHealthcare is expanding the range of tests that will require pre-notification or prior-authorization in its controversial laboratory benefit management program in Florida.
AT THE LAST MINUTE, the American Clinical Laboratory Association has filed suit to block implementation of the looming CLFS price cuts called for by Jan. 1, 2018 — cuts that are expected to be the single most financially-disruptive event in the clinical lab industry in two decades. THE DARK REPORT offers first analysis of this late-breaking story. Also, this issue includes a special look at “Top 10 Lab Stories of 2017” that are related to the impending price cuts.
HERE AT THE DAWN of the new era of value-based healthcare, THE DARK REPORT has uncovered a new trend: The diverging paths of hospital labs and independent lab companies that will severely test the endurance of the independents, radically alter ancillary industries and create fierce new competition among specialty labs. Also in this issue is exclusive analysis of the possibility of upcoming Medicare Part B lab test fee cuts causing big lab companies to try to negotiate higher prices with private health insurers.
IN THIS ISSUE, THE DARK REPORT breaks the news that growing numbers of hospitals are being asked to enter into a “hospital outpatient department” billing arrangement involving lab testing — arrangements that push the limits of federal and state statutes. One common attribute of these HOPD schemes is that the organizers want the hospital, as an in-network provider, to bill for all the lab tests performed in the organizers’ labs. The hospital and the HOPD organizers then split the payments from payers.
IT’S TIME TO ACT: This issue of THE DARK REPORT is devoted entirely to the looming laboratory fee cuts called for by the Protection of Access to Medicare Act — driven by flawed data — that will cause “significant harm” to the lab industry and all patients who depend on it. This issue delivers exclusive analysis of the fast-approaching crisis, and urges pathologists and lab managers to submit comments to CMS by October 23, and also to contact Senators and Representatives, urging a delay in implementation of the fee cuts.
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