Change Health Cyberattack Breaches PHI Here at TDR!

By Robert Michel | From the Volume XXXI, No. 6 – April 29, 2024 Issue

CEO SUMMARY: It was Feb. 21 when cybercriminals attacked Change Healthcare’s claims processing systems. On April 22, UnitedHealth Group issued a statement that PHI for “a substantial proportion of people in America” was breached. We believe the PHI of our employees and T…

Read More

---

UnitedHealth Group Faces DOJ Antitrust Probe

By Robert Michel | From the Volume XXXI, No. 6 – April 29, 2024 Issue

CEO SUMMARY: Recent events have not been kind to UnitedHealth Group and its subsidiaries UnitedHealthcare and Optum. In February, just as UHG’s Change Healthcare division was hit with a major cyberattack that disrupted billions of dolla…

Read More

---

Change Healthcare Hit by Major Cyberattack

By Robert Michel | From the Volume XXXI, No. 4 – March 18, 2024 Issue

CEO SUMMARY: It was a classic ransomware attack against Change Healthcare, the business unit of Optum that is itself a division of UnitedHealth Group. On Feb. 21, this cyberattack shut down critical systems at Change Healthcare, such as those involved in accepting and forwarding prescript…

Read More

---

Attorney Discusses Federal Cases Involving EKRA Violations by Labs

By Robert Michel | From the Volume XXXI, No. 4 – March 18, 2024 Issue

IT’S BEEN MORE THAN FIVE YEARS since Congress passed the Eliminating Kickbacks in Recovery Act of 2018 (EKRA). Lab managers and their attorneys quickly recognized that, whereas the Anti-Kickback Statute (AKS) has a safe harbor that permits percentage-based sales commissions to W2 employees, EKRA does…

Read More

---

January 16, 2024, Intelligence: Late-Breaking Lab News

By Robert Michel | From the Volume XXXI, Number 1 – January 16, 2024 Issue

If a patient’s genetic test generates results that are actionable, will that patient move forward with treatment? That is one question asked by researchers in a study led by Vanderbilt University Medical Center that was published in the American Journal of Human Genetics. …

Read More

---

Violating EKRA Earns Lab Owner an Eight-Year Prison Sentence

By Robert Michel | From the Volume XXX, Number 18 – December 26, 2023 Issue

THIS MAY BE THE MOST HIGH-PROFILE CASE involving a clinical laboratory and the Eliminating Kickbacks in Recovery Act of 2018 (EKRA). Former Arrayit Corporation president Mark Schena was sentenced in October 2023 to eight years in federal prison and ordered to pay $24 million in resti…

Read More

---

Healthcare Fraud Cases Include Decades-Long Cases of Deceit

By Robert Michel | From the Volume XXX, Number 16 – November 13, 2023 Issue

Healthcare fraud cases continue to receive harsh penalties from the federal government as indicated in the case of a California clinical laboratory owner and her husband who attempted to defraud the government of millions of dollars. Lourdes Navarro and husband Imran Shams attempted to defraud ins…

Read More

---

How Private Payers Audit Labs for Possible Claims Fraud

By Virchow | From the Volume XXX, No. 14 – October 2, 2023 Issue

EDITOR’S NOT…

Read More

---

OIG: Billing Code 81408 Is at ‘Risk of Improper Payment’

By Scott Wallask | From the Volume XXX, No. 11 – July 31, 2023 Issue

CEO SUMMARY: Clinical lab executives familiar with molecular test coding and billing will not be surprised to learn that billing code 81408—commonly used on genetic test claims—is at risk of fra…

Read More

---

Lab Execs Allegedly Lied to FDA about Faulty Tests

By Scott Wallask | From the Volume XXX, No. 7 – May 8, 2023 Issue

CEO SUMMARY: Three former executives of a lab testing company face criminal charges. Federal prosecutors claim that the three plaintiffs who previously worked at Magellan Diagnostics flagrantly hid…

Read More

---