TAG:
lab test pricing
Does Anyone Know the Law in California?
WHAT IS THE LAW IN CALIFORNIA THAT DEFINES PROVIDER PRICING and how Medi-Cal should be billed? You probably think that question would be rather easy to answer after you read one of the state statutes that governs pricing relative to Medi-Cal claims. Popularly known among the lab industry as 51501(a),…
What Comes Next in Battle Over Discount Lab Prices?
CEO SUMMARY: Now that the settlement involving Quest Diagnostics Incorporated and the California Attorney General has been announced, attention turns to what comes next with the four remaining defendant lab companies in the whistle-blower lawsuit. There are several different scen…
Helping Uninsured Access Affordable Lab Tests
CEO SUMMARY: Here’s an innovative way to help uninsured and underinsured patients gain access to affordably priced laboratory tests. In Akron, Ohio, physicians organized a partnership between the Summit Country Medical Society and PrePaidLab, LLC, to offer laboratory tests at prices tha…
How Could So Many Labs Violate California Law?
CEO SUMMARY: If a 40-year-old state law on Medi-Cal pricing was known to regulators and clinical laboratories alike, how did the legal and compliance departments of so many laboratories—staffed by some of the smartest legal minds in California and nationally—interpret the law…
Discounted Lab Prices Become Issue in California
CEO SUMMARY: For decades, California’s lab testing market has been considered the Wild West because clinical lab companies have felt relatively free to offer deeply-discounted prices to expand market share and take business away from competitors. Now these discounted pricing pr…
Did Qui Tam Suit Trigger Medi-Cal Price Concerns?
CEO SUMMARY: It is easy to track backwards to understand why the California Department of Healthcare Services (DHCS) began aggressive enforcement of its interpretation of statute 51501(a) against a number of labs this summer. DHCS officials were given a full education and a roadm…
Medi-Cal Gets Tough on Low Lab Test Prices
CEO SUMMARY: This may be the most significant lab industry story of 2010, which has gone unreported until now. Starting in June and July, California’s Department of Health Care Services determined that between 10 and 30 labs had submitted what the agency considers to be false c…
AG Jerry Brown Settles With Westcliff Med Labs
CEO SUMMARY: In California, Attorney General Jerry Brown is making progress in the whistleblower lawsuit alleging that seven lab companies in California violated state law by not giving Medi-Cal, the state’s Medicaid program, the same lowest lab test prices they extend to physi…
California’s Legal Challenge to Discount Pricing
PROBABLY NO TOPIC IN THE LAB TESTING INDUSTRY generates more controversy than discounted pricing for physicians, managed care companies, and IPAs (independent physician associations). Almost every pathologist and laboratory executive decries the corrosive effects of below-cost pricing. Yet, many of …
A Pricing Strategy Soon to Boomerang?
HAVE NATIONAL LAB COMPANIES CREATED A REIMBURSEMENT BOOMERANG that will erode financial stability for the entire laboratory industry in the United States? I ask that question because the Medicare Competitive Bidding Demonstration Project for Laboratory Services has selected San Diego to be its first …
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Volume XXXII, No. 6 – April 21, 2025
Now that a federal judge has vacated the FDA’s LDT rule, The Dark Report analyzes the judgement and notes the various steps the FDA could take in response. Also, lab testing at pharmacies is proving to be less successful than was once anticipated.
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