By Robert Michel, from the Volume XXVI No. 11 – August 12, 2019 issue
CEO SUMMARY: In 2017, an auditor for CMS alleged that True Health filed fraudulent claims and the federal Medicare program cut all payments to the lab company and one month later reduced the cut to 35% of the billed amount. Two months ago, CMS ended all payments again. These facts became public on July 2
By Jon Stone, from the Volume XXV No. 6 – April 16, 2018 issue
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 arrangements and innovative strategies for pricing lab tests. But
By Joseph Burns, from the Volume XXV No. 4 – March 5, 2018 issue
CEO SUMMARY: In the midst of expanding their toxicology testing services nationally, DrugScan and DSI Medical Services (collectively Toxicology Holdings Inc.) hired a brokerage firm last year to pursue a sale of the two toxicology companies. Multiple potential buyers responded with interest. The buyer, ACM Global Laboratories—owned by a health system in Rochester, N.Y.—saw the
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.
CEO SUMMARY: UnitedHealth made national news when it filed a $100 million lawsuit against
By Pamela Scherer McLeod, from the Volume XXV, No. 2 – January 22, 2018 issue
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 legal proceedings involving the healthcare businesses some of the defendants have
By R. Lewis Dark, from the Volume XXIII, No. 8 – June 13, 2016 issue
OFFICIALS AT THE FEDERAL CENTERS FOR MEDICARE & MEDICAID SERVICES are at what may be the most important crossroads in the history of clinical laboratory regulation since Congress passed the CLIA 1988 legislation. Will CMS pursue the severe sanctions it disclosed to Theranos, Inc., and force the lab to close? Or will it soften its
By Robert Michel, from the Volume XVIII No. 14 - October 17, 2011 issue
CEO SUMMARY: Since taking office in 2007, Massachusetts Attorney General Martha Coakley has aggressively pursued civil charges against drug testing labs. Last month, Coakley announced a criminal arrest in one ongoing investigation after a grand jury indicted a physician in a kickback scheme involving lab testing. In four years, Coakley has reached settlements with four
By Robert Michel, from the Volume XVIII No. 9 - July 05, 2011 issue
CEO SUMMARY: Recent events in California, triggered by a lab whistleblower lawsuit filed in 2005 and unsealed in 2009, provide the latest example of how these lawsuits and related government enforcement actions can cause fundamental changes in the pricing and marketing practices that labs and other providers can use while staying within the laws that
By Robert Michel, from the Volume XVII No. 18 - December 27, 2010 issue
CEO SUMMARY: If a 40-year-old state law on Medi-Cal pricing was known to regulators and clinical laboratories alike, how did the legal and compliance departments of so many laboratories—staffed by some of the smartest legal minds in California and nationally—interpret the law in such a different way as the state’s primary laboratory regulator? After all,
By Robert Michel, from the Volume XVI No. 15 - November 02, 2009 issue
CEO SUMMARY: There were plenty of headlines about the passage of HITECH last February because of how it expanded funding for electronic medical records. But lesser known are new requirements that providers, including labs and pathology groups, must now take specific compliance actions in response to breaches involving protected health information (PHI). Enforcement of these
