Tag: medicaid fraud

Ex-UroCor Execs Face Criminal Indictments

CEO SUMMARY: Criminal charges filed against ex-UroCor executives center around several marketing practices that have much in common with marketing strategies used by many lab- oratories today. These include discounted pricing for non-Medicare specimens, offering to waive charges to payers and patients where UroCor was an “out-of-network” provider, and offering “consulting services” payments to client

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Health Line Clinical Labs, ChromaVision, Cytyc, TriPath, Quest Diagnostics

DESPITE THE EVIDENCE that packing unnecessary tests into test panels is not acceptable to Medicare and Medicaid authorities, some laboratories continue the practice.

Health Line Clinical Laboratories, Inc. (HLCL) of Burbank, California is the latest lab company to pay a significant fine to settle allegations of

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California Medicaid Prepares To Issue Lab Contracts

CEO SUMMARY: California Medi-Cal officials may be creating more problems than they solve with their latest scheme to have independent laboratories sign contracts with their Medicaid program—while excluding hospital laboratory outreach programs and labs operated from physicians’ clinics and offices. Nominally, the goal is to reduce fraudulent lab test claims submitted to the California Medicaid

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Lab Marketing Strategy Triggers Legal Concerns

CEO SUMMARY: That famous phrase “everyone wants something for nothing” does not describe TennCare Select’s reaction to the “free testing” that Quest Diagnostics is performing for its beneficiaries. TennCare provides a real-world example of how this strategy can put a laboratory at odds with an important payer in a region. An experienced healthcare attorney assesses

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Issues At Columbia/HCA Exist At Other Hospitals

CEO SUMMARY: Even as federal regulators attract big headlines in their investigation of Columbia/HCA, laboratory administrators in a variety of hospital settings may be surprised in the future to find federal investigators scrutinizing the billing practices at their institution. Columbia’s investigation reveals that federal prosecutors will use precedents in earlier laboratory billing cases as a

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SmithKline Announces $325 Million Settlement

CEO SUMMARY: Prosecutors continue to investigate. Criminal charges could be forthcoming against the company and individuals. Allegations against SmithKline expand the scope of laboratory practices that government regulators consider to be violations of existing statutes.

Despite the fact that Smithkline Beecham’s settlement was expected, details of the case generated surprise among lab industry executives.

At $325 million,

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