CEO SUMMARY: In a lawsuit filed in the U.S. District Court for the Central District of California, Anthem and affiliated Blue Cross Blue Shield plans alleged that 37-bed Sonoma West Medical Center, a Florida lab testing company, a medical billing company, and others used a pass-through lab test billing scheme to defraud Anthem and its
Tag: medical billing
CEO SUMMARY: As the debate grows more heated, supporters of hospital outpatient department (HOPD) billing schemes have ramped up their defense of the practice. The president of the National Association of Rural Hospitals tells THE DARK REPORT that rural hospitals are permitted to bill for hospital lab outreach program services under Medicare’s 70/30 shell rule.
This is an excerpt from a 2,000-word article in the May 29, 2018 issue of THE DARK REPORT. The complete article is to all readers as long as the article limit has not been reached, and always available to paid members of the Dark Intelligence Group.
CEO SUMMARY: Seeking the higher lab-test payment rates that insurers
CEO SUMMARY: In court papers, Cigna alleged that HDL misrepresented patients’ responsibilities by promising not to collect co-payments, co-insurance, or deductibles. Also, HDL promised not to seek reimbursement from patients for any portion of its bills that the health insurer did not cover, the court documents show. HDL misleadingly billed the health insurer at exorbitant
Globalization of laboratory medicine continues to move forward. Two recent examples illustrate this trend. Earlier this month, the University of Pittsburgh Medical Center (UPMC) announced that it had entered into an agreement with the Citizens Hospital of Hyderabad, India, to form a clinical pathology laboratory in that city. The laboratory will be located on the
CEO SUMMARY: New rules requiring use of National Provider Identification (NPI) numbers took effect on May 23. Since then, Medicare carriers and payers nationwide have rejected claims from pathologists and other providers that do not comply with the new NPI rules. A missing NPI on just one claim will result in the front-end rejection of
CEO SUMMARY: Coding, billing, collections, and compliance continue to grow in complexity, making management of the lab’s revenue cycle ever more difficult. One by one, a number of the nation’s largest laboratories are taking steps to automate management of their revenue cycle by utilizing “Software as a Service” (SaaS). Intrigued by this new market trend,
In California, some physicians continue to seek illegal kickbacks from clinical laboratories. The problem is widespread enough that the FBI has conducted several “sting operations.” In a jury trial related to the long-running “Durascam” healthcare fraud investigation, a married pair of doctors, Adelina Vorperian, M.D. and Kevork Vorperian, M.D., were convicted on charges of accepting