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…

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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…

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March 22, 2021 Intelligence: Late-Breaking Lab News

By Robert Michel | From the Volume XXVIII, No. 4 – March 22, 2021 Issue

This may be the nation’s first federal case of fraud and abuse involving a clinical laboratory company specializing in microbiome testing. In San Francisco last week, federal prosecutors filed multiple criminal charges against bankrupt uBiome, formerly based in San Francisco, Jessica Richman…

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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 inve…

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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 b…

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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 r…

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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 n…

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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…

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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 Sh…

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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 …

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