healthcare fraud

Tag: healthcare fraud

DOJ Charges 35 Individuals In Genetic Testing Scam

By Joseph Burns, from the Volume XXVI No. 14 – October 14, 2019 issue

CEO SUMMARY: Federal prosecutors said those charged illegally lured elderly patients nationwide into giving cheek swabs for fraudulent genetic tests. The indicted individuals allegedly paid kickbacks and bribes to medical professionals working with telemedicine companies in exchange for referring Medicare beneficiaries for unnecessary genetic tests. Indictments were announced on Sept. 27 in an investigation that

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Labs Must Respond to New CMS Anti-Fraud Rule

By Joseph Burns, from the Volume XXVI No. 14 – October 14, 2019 issue

CEO SUMMARY: Clinical labs and pathologists providing tests for patients in Medicare, Medicaid, or Children’s Health Insurance Program should become acquainted with new enrollment rules that go into effect Nov. 4. The new rules allow CMS to revoke or deny enrollment to help stop fraud before it occurs in the federal healthcare programs. CMS intends

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Are Feds Now More Serious about Prosecuting Fraud?

By R. Lewis Dark, from the Volume XXVI No. 14 – October 14, 2019 issue

IS IT A COINCIDENCE THAT, IN THIS ISSUE OF THE DARK REPORT, we cover two related developments, both involving the federal government’s efforts to control healthcare fraud and abuse?

First, you’ll read about the new federal rule scheduled to take effect on Nov. 4. It gives federal healthcare investigators new powers to exclude individuals and organizations

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New Opioid Law Hits Labs Paying Sales Commissions

By Joseph Burns, from the Volume XXV No. 17 – December 3, 2018 issue

CEO SUMMARY: At the last minute, Congress added all clinical laboratories to a far-reaching anti-kickback provision in the newly-enacted Support for Patients and Communities Act. This provision applies to all payers, both government and private. Lab experts say this new law could have a negative effect on patient care because it could make relatively innocuous

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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 Consultants Inc. The damages and penalties were imposed on the defendants

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Insurers Sue To Challenge Pass-Through Bill Schemes

By Joseph Burns, from the Volume XXV No. 7 – May 7, 2018 issue

CEO SUMMARY: In two separate lawsuits filed in April, UnitedHealthcare (UHC) and Anthem each charged that drug testing companies used pass-through-billing schemes in ways the insurers say are fraudulent. UHC filed its lawsuit on April 18. One day later, on April 19, Blue Cross and Blue Shield of Georgia and other Anthem companies filed suit

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Allegations in UHC health insurance fraud case involve multiple defendants

By Mary Van Doren

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

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Allegations of Lab Test Fraud Involve Multiple Defendants

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

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Lab Scheme Recruits Hospitals To Bill as In-Network Providers

By Joseph Burns, from the Volume XXIV, No. 15 – October 30, 2017 issue

CEO SUMMARY: Management companies using a new generation of potentially fraudulent schemes are targeting hospitals and health systems for arrangements that use questionable means to increase lab test volume and revenue. The management companies often use the term “hospital outpatient department (HOPD) billing model” to describe these arrangements. The scammers want the hospitals, as in-network

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Positive Patient ID System Catches Patients Cheating on Toxicology Tests

By Pamela Scherer McLeod, from the Volume XXIV, No. 13 – September 18, 2017 issue

CEO SUMMARY: The urine drug testing industry is challenged every day to detect the large number of patients trying to cheat on their drug tests. GenoTox Laboratories of Austin, Texas, developed a DNA-authentication method for urine samples that allows the lab to detect when patients have used a substitute for urine when undergoing medication- and

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Tag: healthcare fraud

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