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 Consultants Inc. The damages and penalties were imposed on the defendants
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. 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 necessity, noted the law firm McDonald Hopkins in a
This is an excerpt from a 2,700-word article in the February 12, 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 outcome of the latest Medicare health insurance fraud trial has
By Robert Michel, from the Volume XXV No. 3 – February 12, 2018 issue
CEO SUMMARY: After a two-week trial, the executives of Health Diagnostic Laboratories and BlueWave Healthcare Consultants were found guilty of violating the federal False Claims Act. Defendants Tonya Mallory, Floyd Calhoun Dent III, and Robert Bradford Johnson were ordered to pay the United States millions for causing HDL to submit more than 35,000 false claims
By R. Lewis Dark, from the Volume XXV No. 3 – February 12, 2018 issue
RATHER THAN ENTER INTO A NEGOTIATED SETTLEMENT with federal prosecutors, the former executives of Health Diagnostic Laboratory (HDL) and BlueWave Healthcare Consultants decided to take their case to a jury in a federal court in South Carolina. The outcome has notable lessons for all lab managers and pathologists, as well as the attorneys who advise
By Joseph Burns, from the Volume XXIII No. 4 – March 21, 2016 issue
This article is an excerpt from a 1,500-word article in the March 21 issue of THE DARK REPORT. Full details of UHC’s battle against out-of-network labs, as well as its plans to begin requiring pre-authorization for genetic testing, are included in the original article, available to paid members.
IN ITS LATEST NETWORK BULLETIN, UnitedHealthcare warned out-of-net- work laboratories
By Joseph Burns, from the Volume XXIII No. 4 – March 21, 2016 issue
CEO SUMMARY: UnitedHealthcare directly tackled the issue of out-of-network labs waiving or capping copayments, coinsurance and deductibles that are to be paid by patients. In a network bulletin this month, UHC said that such arrangements may violate federal law and could lead to state insurance department investigations into false claims. In the same bulletin to
By Joseph Burns, from the Volume XXII NO. 16 - November 16, 2015 issue
IN ANOTHER MAJOR LAB FRAUD CASE, toxicology lab company Millennium Health will pay $256 million to settle allegations in a whistleblower lawsuit that it overbilled federal healthcare programs for unnecessary lab testing. Just 22 days after this agreement, Millennium Health filed a petition for a pre-packaged Chapter 11 bankruptcy on November 10.
In papers submitted to
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 Medicare contractor. Another source of risk for labs
