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medicare billing

OIG Moves to Address “Usual Charge” Issue

CEO SUMMARY: Federal regulators are taking another crack at defining “usual charges.” Language in the proposed rules published last month precisely defines which payers should be included in determining “usual charges” and what charge basis to use for specific payers. Once effecti…

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Tenet’s Outlier Medicare Fees Put It in Unwelcome Spotlight

MEDICARE CODING AND BILLING policies at Tenet Healthcare Corporation have come under scrutiny by both Medicare officials and Wall Street analysts. Attention is centered around how Tenet aggressively pursued Medicare reimbursement under “outlier” formulas. These formulas are designed to supplemen…

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Specialty Lab’s Woes Trigger Big Market Shift

IT’S THE UNPUBLICIZED STORY BEHIND THE STORY. Most of the laboratory industry knows that Specialty Laboratories, Inc. is the target of sanctions issued by both federal and state laboratory regulators. But the impact of this development has yet to be recognized across the industry. …

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Specialty Labs Coping With Unique Challenges

CEO SUMMARY: Few laboratory executives have ever been tested as intensely as those of Specialty Laboratories, Inc. Since the first of the year, Quest Diagnostics Incorporated has purchased two of its biggest lab clients. In April, state and federal lab regulators issued sanctions. Both de…

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State, Federal Regulators Target Specialty Labs

CEO SUMMARY: Specialty Laboratories, Inc. has earned the dubious honor of being the first-ever publicly-traded laboratory to have its CLIA-88 license revoked by federal regulators, terminating its right to payment for services covered by Medicare and Medicaid. The revocation is slated to …

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DIANON Systems, UroCor, Cytyc, Digene, McKesson HBOC,, Abbott

FEDERAL ATTORNEY SERVES SUBPOENA ON DIANON SYSTEMS NEWS BROKE LAST WEEK that DIANON Systems, Inc. had received a subpoena from the U.S. Attorney’s Office in Connecticut for documents relating to laboratory billing. Apparently “LabScam” is still alive …

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Medicare Refund Request Issued To AmeriPath, Inc

CEO SUMMARY: Regulators believe AmeriPath’s Ft. Lauderdale laboratory submitted claims during 1996 which were based upon improper procedure codes or lacked adequate documentation. AmeriPath “vigorously” disputes the situation. It is still uncertain as to whether this action represen…

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1997’s Top Ten Lab Stories Predict New Directions

CEO SUMMARY: Events during 1997 reveal that the laboratory industry continues to undergo fundamental change. Yet even amidst the industry’s downsizing, selected laboratory organizations continue to flourish. Here is THE DARK REPORT’s annual look at top stories for the year. A careful …

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Ohio Hospital Lab Lawsuit Tossed Out By The Judge

CEO SUMMARY: Hospitals in Ohio now find themselves at square one again in their efforts to stop federal prosecutors from continuing the statewide investigation of laboratory billing practices. The judge’s legal ruling denied jurisdiction to hear the case and did not address any of the a…

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Making $1 Billion Disappear

MOST PEOPLE WOULD AGREE WITH ME THAT $1 BILLION IS A HUGE AMOUNT of money. It generally takes the federal government to squander amounts that big. The Internal Revenue Service’s $2 billion computer boondoggle is the latest example of government incompetence with taxpayers’ money…

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