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Attorney Says Labs Face Increased Legal Liability

CEO SUMMARY: For many reasons, including cuts to lab test prices that health insurers pay, narrow networks, and more competition for lab test referrals, a significant number of lab companies are seeking ways to increase market share. These methods include the use of new laboratory test ar…

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Anthem accuses tiny hospital of pass-through billing scheme

This is an excerpt from a 1,300-word article in the March 5, 2018, issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. CEO SUMMARY: THE…

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Anthem Seeks $13.5M from California Hospital

CEO SUMMARY: Anthem charged 37-bed Sonoma West Medical Center in Sebastopol, Calif., of engaging in an improper billing scheme to defraud Anthem and its affiliated Blue Cross and Blue Shield plans. In effect, the charge is a notification to SWMC that Anthem intends to sue SWMC and its…

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Use of ‘1099 Marketers’ and Lab Compliance Risk

CEO SUMMARY: Experts in lab compliance predict that clinical laboratories and anatomic pathology groups must anticipate tougher enforcement of federal and state laws this year. One source of increased compliance risk for lab companies is the rising use of third-party marketing agreements….

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Insights from Jury Verdict in HDL, BlueWave Case

CEO SUMMARY: After a two-week trial, the executives of Health Diagnostic Laboratories and BlueWave Healthcare Consultants were found guilty of violating the federal False Claims Act. Defendants Tonya Mallory, Floyd Calhoun Dent III, and Robert Bradford Johnson were ordered to pay the Unit…

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Pulling Aside the Curtain on Alleged Lab Fraud

IN RECENT YEARS, MANY CLINICAL LAB ADMINISTRATORS AND PATHOLOGISTS have looked with dismay at the increased fraud associated with the laboratory test referrals of office-based physicians. High-profile federal cases involving lab companies accused of fraud garner national headlines. Small companies s…

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Allegations in UHC health insurance fraud case involve multiple defendants

This is an excerpt from a 5,000-word article in the January 22, 2018, issue of THE DARK REPORT. The complete article is available for a limited time to all readers, and available at all times to paid members of the Dark Intelligence Group. …

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Allegations of Lab Test Fraud Involve Multiple Defendants

CEO SUMMARY: UnitedHealth made national news when it filed a $100 million lawsuit against Next Health and other defendants in Dallas in January 2017. The insurer alleged fraud involving clinical laboratory tests. That lawsuit is just the latest chapter in an almost decade-long string of …

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Former HDL CEO Mallory Sues Richmond Law Firm

CEO SUMMARY: It’s a case of the client turning on the law firm. The former CEO of Health Diagnostic Laboratory is suing the law firm that advised her and her lab company on major legal matters. LeClairRyan of Richmond, Va., previously settled certain allegations with HDL’s bankruptcy …

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