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hospital laboratory billing

DOJ Indicts Ten Individuals for Pass-Through Lab Test Billing Fraud

PASS-THROUGH LAB TEST BILLING SCHEMES involving rural hospitals and $1.4 billion in fraudulent lab test claims are at the core of multiple indictments announced recently by the federal Department of Justice (DOJ). Ten individuals—including laboratory owners, billing company…

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UHC Ready to Implement New Lab Test Registry

CEO SUMMARY: UnitedHealthcare announced that its new Test-Registry Protocol will become effective on Jan. 1, 2021, creating a major billing hurdle for labs and pathology groups. By that date, a lab must register each type of test before it can submit claims for these tests to the nati…

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New UnitedHealthcare Policy For Hospital Reference Tests

>CEO SUMMARY: Under a new policy UnitedHealthcare will start in May, hospital laboratories will no longer be allowed to bill for reference testing for members who are not hospital patients. The policy is likely to affect clinical lab testing for patients whose testing goes …

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Ohio Hospitals Prevail in Suit Against Federal Lab Claims

IT TOOK FIVE YEARS, but federal courts finally gave victory to the Ohio Hospital Association (OHA) in its long-running battle against federal regulators over laboratory test billing issues. Early last month, the OHA signed a settlement with the federal government which resolves the …

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Warning Ahead: Investigation And Litigation

NEWS THAT PRIVATE INSURERS FILED A MAJOR LAWSUIT against SmithKline Beecham last Thursday confirms something I’ve wondered about for several years. What would be the private insurer’s perspective on the same laboratory billing and reimbursement practices which triggered federal settlements with …

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Private Insurers Sue SmithKline, Feds Pursue Labs In Six States

FRAUD AND ABUSE for laboratory billing is an issue which refuses to disappear. Private insurers filed a lawsuit against SmithKline Beecham last Thursday, seeking unspecified damages related to overcharging for laboratory testing during the years 1989-1995. At the same time, news eme…

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Probe of Columbia/HCA Generates Indictments

CEO SUMMARY: Hospital laboratory executives should pay close attention to how federal prosecutors develop their case against Columbia/HCA. Earlier “Labscam” settlements with commercial laboratories and hospital laboratory billing practices centered around restitution and fines for imp…

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