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
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 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
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
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
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
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
By Joseph Burns, from the Volume XXIII, No. 2 - February 8, 2016 issue
CEO SUMMARY: It was a surprise to the Florida Attorney General that a bill had surfaced in the Florida Legislature to amend the existing state law’s definition of usual and customary pricing to the Medicaid program. The bill would even make that change in definition retroactive. If this bill clears the legislature and becomes law,
By R. Lewis Dark, from the Volume XXII NO. 13 - September 14, 2015 issue
CEO SUMMARY: Court documents filed last month in the federal qui tam case against Health Diagnostic Laboratory, Singulex, Berkeley Heart Lab, BlueWave Healthcare Consultants, and several lab executives allege that the defendants used illegal inducements and kickbacks to file false claims and generate payments of $500 million from Medicare and Tricare. This money was paid in just 60 months, from 2010 through 2014. Add up payments to the defendants from private insurers-two of whom are suing HDL-and the total could be as much as $1.2 billion.
By Robert Michel, from the Volume XXII NO. 9 - June 22, 2015 issue
PHYSICIANS WHO PARTICIPATE IN schemes that violate anti-kickback and fraud statutes will be at greater risk of prosecution by federal healthcare officials. This development comes following the June 9 release by the OIG of “Fraud Alert: Physician Compensation Arrangements May Result in Significant Liability.”
