TAG:
billing medicare
DOJ Says Georgia Man Got Kickbacks for COVID-19 Tests
By Joseph Burns | From the Volume XXVII No. 6 – April 20, 2020 Issue
JUST WEEKS AFTER THE FIRST CASES OF SARS-CoV-2 appeared in the United States, federal prosecutors filed criminal charges in a COVID-19 lab test fraud scheme. Erik Santos, 49, of Braselton, Ga., was charged with conspiracy to defraud federal and private healthcare programs by submitting fraudule…
UTC Labs to Pay $41.6 Million in a Civil Settlement With DOJ
By Joseph Burns | From the Volume XXVI No. 15 – November 4, 2019 Issue
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 F…
Labs Have Heavy Burden to Report Lab Price Data
By Joseph Burns | From the Volume XXIII No. 15 – November 7, 2016 Issue
CEO SUMMARY: Clinical labs must assess their responsibilities to report lab test market prices to CMS as part of the Protecting Access to Medicare Act. A panel of three experts took up this topic at a recent webinar hosted by THE DARK REPORT. On June 23, the federal Centers for Medicaid &…
Is New Cycle of Laboratory Fraud Plaguing the Industry?
By Mary Van Doren | From the Volume XXII No. 12 – August 24, 2015 Issue
CEO SUMMARY: Taken collectively, the growing number of federal investigations of lab companies and health insurer lawsuits against lab companies alleging fraudulent busine…
Is New Cycle of Fraud Plaguing Lab Industry?
By Robert Michel | From the Volume XXII No. 12 – August 24, 2015 Issue
CEO SUMMARY: Taken collectively, the growing number of federal investigations of clinical lab companies and health insurer lawsuits against lab companies alleging fraudulent business practices signals a disturbing new trend for the lab industry. Although these allegations are lev…
Experts Say Labs May Start to Receive MDx Payments
By Joseph Burns | From the Volume XX No. 5 – April 15, 2013 Issue
CEO SUMMARY: In the fourth month of the current year, there is plenty of confusion and uncertainty over how the Medicare program will establish prices for the new molecular CPT codes and when both government and private payers will begin to regularly reimburse laboratorie…
Lawyer Advises on Risk Of Prostate Biopsy Audits
By Joseph Burns | From the Volume XIX No. 13 – September 17, 2012 Issue
CEO SUMMARY: For labs currently processing prostate biopsy cases with five or more cores and for those pathologists interpreting those cases, there is a lack of clarity about new Medicare policies. As one example, risk of an audit is significant because of recent guidance issued by one Me…
CMS Anti-Markup Rules Target In-Office Ancillaries
By Robert Michel | From the Volume XV No. 10 – July 28, 2008 Issue
CEO SUMMARY: Medicare officials are again attempting to rein in what they consider to be potentially abusive forms of in-office ancillary services, including anatomic pathology. Proposed new rules published this month would clarify and perhaps expand the application of the Medicare anti-m…
Ruling Against UroPath Signals More Fed Action
By Robert Michel | From the Volume XV No. 7 – May 27, 2008 Issue
CEO SUMMARY: It was a signal win for federal healthcare officials when a federal district court judge in Washington, DC, dismissed a case brought by UroPath, LLC. UroPath had sued HHS Secretary Michael Leavitt seeking to challenge the physician fee schedule final order and the anti-markup…
Judge Rules Against Labs In Medicare Lab Bid Case
By Robert Michel | From the Volume XV No. 3 – March 3, 2008 Issue
CEO SUMMARY: On February 14, Federal District Judge Thomas J. Whelan denied the request for a temporary restraining order (TRO) by three San Diego labs that would have stopped the Medicare Laboratory Competitive Bidding Demonstration pilot project until several legal challenges were adjud…
CURRENT ISSUE
Volume XXXI, No. 14 – October 14, 2024
For the second time in the past 16 months, respected health systems have taken steps to collaborate specifically to advance value-based care. Also, several statewide pilot programs—each involving tens of thousands of newborns—are publishing studies that demonstrate how exome, whole genome sequencing, and rapid whole genome sequencing can deliver both improved patient outcomes and a return on investment.
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