TAG:
healthcare fraud
Insurers Sue To Challenge Pass-Through Bill Schemes
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…
Allegations in UHC health insurance fraud case involve multiple defendants
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. …
Allegations of Lab Test Fraud Involve Multiple Defendants
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 …
Lab Scheme Recruits Hospitals To Bill as In-Network Providers
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 de…
Positive Patient ID System Catches Patients Cheating on Toxicology Tests
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 …
Florida AG Opposes Bill Over Customary Charges
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…
New Developments in $1 Billion Lab Fraud Case
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 c…
OIG Says It Is Ready to Target Physicians in Kickback Cases
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 Li…
Medicare Special Stain LCD May Hinder Pathology Workflow
CEO SUMMARY: Under a proposed rule for Medicare region J-11, a pathologist will no longer be able to use “reflex templates or pre-orders for special stains and/or IHC stains prior to review of the routine H&E.” While the proposed LCD is designed to target a relatively small number…
Path Group Responds to FBI Visits in Stokes Case
CEO SUMMARY: As the FBI launched its investigation of fraudulent billing by Michigan dermatologist Robert W. Stokes, D.O., two years ago, staff at several pathology labs found themselves “up close and personal” with federal healthcare fraud prosecutors. One pathology lab, based on wha…
CURRENT ISSUE
Volume XXXIII, No. 4 – March 23, 2026
A federal court ruling has established a safe harbor for clinical labs when they run tests ordered by physicians. Lab leaders should examine this briefing for pitfalls. Also, it turns out that providers may be ordering inappropriate vitamin D tests, according to one expert.
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