TAG:
false claims act
After Two-Year Battle with CMS, True Health on Verge of Collapse
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 …
Pathology Firm Pays $63M to Settle Qui Tam Case
By Joseph Burns | From the Volume XXVI No. 3 – February 25, 2019 Issue
CEO SUMMARY: Inform Diagnostics, formerly Miraca Life Sciences, settled the federal qui tam case while denying wrongdoing. The $63.5 million settlement will by paid by the former owner, Miraca Holdings, a Japanese company. The federal Department of Justice alleged that the company—then …
Several Big Surprises in 2018’s Top 10 Lab Stories
By Robert Michel | From the Volume XXV No. 18 – December 24, 2018 Issue
CEO SUMMARY: This year’s list of the Top 10 Lab Industry Stories for 2018 is dominated by new directives from Medicare and private health insurers, as well as significant decisions by federal courts. Collectively, these developments create new compliance risks for all clinical laborator…
Defunct, Oft-Troubled Calloway Labs Hit with $1.4M Federal Judgement
By Robert Michel | From the Volume XXV No. 14 – October 1, 2018 Issue
HOW OFTEN IS A DEFUNCT LAB COMPANY IN THE NEWS? That was the odd development last week when it was announced that a U.S. District Court had entered a $1.4 million civil judgement against Calloway Laboratories, Inc., a toxicology lab company formerly based in Woburn, Mass., for busine…
Peeking at Whistleblower Claims: How Labs Induce Physicians
By Robert Michel | From the Volume XXV No. 14 – October 1, 2018 Issue
IN RECENT DECADES, probably no sector of the U.S. healthcare system has seen the level of fraud and abuse that seems to pervade the clinical laboratory industry. The common perception is that illegal inducements between lab companies and referring physicians are rampant and federal prosecutors have f…
In HDL Case, Judge Imposes Damages, Penalties of $114 Million
By Joseph Burns | From the Volume XXV No. 8 – May 29, 2018 Issue
LAST WEEK, A FEDERAL JUDGE in South Carolina issued an order imposing civil damages and penalties of more than $114 million on Tonya Mallory, the former CEO of Health Diagnostic Laboratory, in Richmond, Va., and two owners of the lab’s marketing partner, BlueWave Healthcare…
Attorney Says Labs Face Increased Legal Liability
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 ar…
D.C. Circuit Court Reverses Medical Necessity Ruling
By Joseph Burns | From the Volume XXV No. 5 – March 26, 2018 Issue
MANY LAB EXECUTIVES were concerned last year after a judge in the District of Columbia Circuit Court ruled that clinical laboratories need to determine that all lab test services physicians order are medically necessary. The court also ruled that ordering physicians do not need to determine medical …
Anthem Seeks $13.5M from California Hospital
By Joseph Burns | From the Volume XXV No. 4 – March 5, 2018 Issue
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…
Anthem accuses tiny hospital of pass-through billing scheme
By Mary Van Doren | From the Volume XXV No. 4 – March 5, 2018 Issue
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…
CURRENT ISSUE
Volume XXXI, No. 4 – March 18, 2024
An expert attorney analyzes the most recent cases of EKRA violations, showing how many labs could be in violation themselves. Also, a major cyberattack on Change Healthcare, owned by UnitedHealth Group, creates disruptions to providers around the country. Other news includes a look at the worldwide pathologist shortage.
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