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Ruling Against UroPath Signals More Fed Action
CEO SUMMARY: It was a signal win for federal healthcare officials when a federal district court judge in Washington, DC, dismissed a case brought by UroPath, LLC. UroPath had sued HHS Secretary Michael Leavitt seeking to challenge the physician fee schedule final order and the anti-markup…
Mich. Dermatologist Gets 10.5 Years in Fraud Case
CEO SUMMARY: In a federal case involving billing improprieties and insurance fraud, a federal judge sentenced Michigan dermatologist Robert W. Stokes, M.D., to 126 months in prison and ordered him to pay $178,100 in fines and assessments, with the amount of restitution yet to be determine…
Medicare Rules Tighten Anatomic Path Mark-ups
CEO SUMMARY: Effective on January 1, 2008, new rules take effect that restrict the circumstances under which physicians can mark up the anatomic pathology services provided to their patients. However, ambiguities in how the rules are written are likely to make the intent of the new rules …
Lab Billing Indictments Underscore Docs’ Risks
CEO SUMMARY: Physicians should consider the precedent established recently when the U.S. Attorney for the Western District of Michigan obtained a 72-count indictment against a local dermatologist, including 35 counts of submitting fraudulent claims for lab tests he did not perform, as wel…
$18 Million Judgment for Errors by Laboratory
CEO SUMMARY: In a wrongful birth lawsuit, a high-risk pregnancy physician in New Jersey requested a cytogenetics test on a pregnant mother, but LabCorp’s cytogenetics lab never did the test. After the baby was born with myotubular myopathy—the same deformity the mother had sought to p…
Office-Based Docs Want Anatomic Path Revenues
CEO SUMMARY: Specialist physicians think they’ve found gold in anatomic pathology services. Indifferent regions of the United States, urologists and gastroenterologists are taking active steps to cut themselves a piece from the anatomic pathology revenue pie. Some physician groups are b…
Proposed Coding Edits May Restrict 88305 Use
CEO SUMMARY: When the Medicare contractor tasked with developing MUEs (Medically Unbelievable Edits) for this year’s Correct Coding Initiative work released the proposed list of edits to the AMA, it didn’t take long for the bad news to reach the pathology profession. Restriction on un…
New OIG Opinion 05-08 On Phlebotomy Fees
CEO SUMMARY: At the request of a yet-unidentified laboratory, the Office of the Inspector General issued Advisory Opinion 05-08 last month. It is a negative opinion on a proposed arrangement where a laboratory would reimburse client physicians as much as $6 for each blood draw performed b…
Physician Group Path Ventures To Undergo OIG Review in 2005
IN ITS FISCAL YEAR 2005 WORK PLAN, the Department of Health and Human Services (DHHS) Office of Inspector General (OIG) will “identify and review relationships between physicians who furnish pathology services in their offices and outside pathology companies.” I…
Lawyer Argues: UroCor Charges Are a Concern
CEO SUMMARY: Criminal charges in the case against three ex-UroCor executives will likely alter existing compliance practices that affect how a lab offers price discounts to physicians and the way a lab uses “waiver of charges” in situations where it is an out-of-network provider. Atto…
CURRENT ISSUE
Volume XXXI, No. 6 – April 29, 2024
Laboratory managers will want to note that The Dark Report itself was targeted by the fraudsters who hit Change Health in a cyberattack. Also, one lab has some innovative methods of combatting the chronic staffing shortage, including hiring college graduates and students.
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