CEO SUMMARY: In a lawsuit filed in the U.S. District Court for the Central District of California, Anthem and affiliated Blue Cross Blue Shield plans alleged that 37-bed Sonoma West Medical Center, a Florida lab testing company, a medical billing company, and others used a pass-through lab test billing scheme to defraud Anthem and its
Tag: billing service
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 DARK REPORT was the first to draw attention to the
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 owner if it does not recover the $13.5 million in a timely
CEO SUMMARY: Healthcare’s transformation is now far enough along that most clinical labs and pathology groups are either feeling the financial pain or are excitedly developing ways to deliver more value from lab testing services. On April 26-27, at the 21st annual Executive War College on Lab and Pathology Management, expert speakers will address how
CEO SUMMARY: Seeing the changes overtaking pathology practices, Brazos Valley Pathology decided to sell two of its group practices to Aurora Diagnostics. Last month’s transaction was not designed to fix financial problems nor was it because of retiring pathologists. Rather, it was done proactively to ensure that BVP’s 11 pathologists had access to the resources of a larger pathology organization so that they could expand or add technology as needed in the future, while practicing independently.
Globalization of laboratory medicine continues to move forward. Two recent examples illustrate this trend. Earlier this month, the University of Pittsburgh Medical Center (UPMC) announced that it had entered into an agreement with the Citizens Hospital of Hyderabad, India, to form a clinical pathology laboratory in that city. The laboratory will be located on the
WHEN A BILLING SERVICE company disposes of patients’ lab test records, it should do so in compliance with federal and state privacy rules. That means all protected health information (PHI) should be shredded or incinerated.
Four pathology groups in Massachusetts learned this lesson the hard way when they and their billing company agreed to pay collectively
FACED WITH THE FACT that many payers were not ready to implement the 5010 standard under the Health Insurance Portability and Affordability Act (HIPAA), on March 15, the federal Centers for Medicare & Medicaid Services (CMS) announced a second delay in enforcement of the standard. The extension is until June 30.
As of March 15, CMS
CEO SUMMARY: Pathologists at four Massachusetts hospitals got a powerful reminder recently that a breach of protected health information (PHI) can occur at any time for the most unexpected reason. Earlier this month, the Boston Globe reported that the pathology reports and patient information for tens of thousands of individuals had been found unshredded and
CLARIENT INKS PACT WITH GENERATION HEALTH FOR GENETIC TESTING
PAYER PRE-AUTHORIZATION OF GENETIC TESTS is the reason for the newly-announced contract between Clarient, Inc., and Generation Health, Inc., of Upper Saddle River, New Jersey.
Announced on June 10, the agreement positions Clarient to be the preferred provider of genetic tests for Generation Health. Generation Health was founded