This is a synopsis of three in-depth articles in the Aug. 12, 2019 issue of THE DARK REPORT (TDR). The full articles are available to members of The Dark Intelligence Group.
CEO SUMMARY: In 2017, an auditor for CMS alleged that True Health Diagnostics filed fraudulent claims and the federal Medicare program cut all payments to
Tag: Medicare
ACLA Gets Procedural Win in Its Appeal of PAMA Case
By Joseph Burns, from the Volume XXVI No. 11 – August 12, 2019 issue
IN A SIGNIFICANT WIN for the American Clinical Laboratory Association (ACLA) and other groups suing federal Department of Health and Human Services (HHS), the U.S. Court of Appeals for the District of Columbia ruled in the ACLA’s favor on July 30.
Ruling on the appeal in the case the ACLA brought against HHS Secretary Alex Azar
After Two-Year Battle with CMS, True Health on Verge of Collapse
By Robert Michel, from the Volume XXVI No. 11 – August 12, 2019 issue
CEO SUMMARY: In 2017, an auditor for CMS alleged that True Health filed fraudulent claims and the federal Medicare program cut all payments to the lab company and one month later reduced the cut to 35% of the billed amount. Two months ago, CMS ended all payments again. These facts became public on July 2
Dermatologists Say Anthem Cuts Affect Patient Care
By Joseph Burns, from the Volume XXVI No. 11 – August 12, 2019 issue
CEO SUMMARY: Deep cuts in what Anthem pays pathologists for the professional component for certain AP services are having a harmful effect on the long-standing relationships that dermatologists have with dermatopathologists, some physicians say. By disrupting these relationships, Anthem is harming patient care, they add. Since late last year, in a growing number of states,
How Lab Fraud Hurts Hospital Labs, Pathologists
By R. Lewis Dark, from the Volume XXVI No. 11 – August 12, 2019 issue
ONCE AGAIN, A HIGH-PROFILE LAB COMPANY faces allegations of fraud and abuse. This time it is True Health Diagnostics of Frisco, Texas. Details of this case were revealed last month when True Health filed a lawsuit in a federal court in Texas against the agencies running the federal Medicare program.
In its lawsuit, True Health denies
CMS Sanctioned Three Houston Hospitals, Labs
By Joseph Burns, from the Volume XXVI No. 10 – July 22, 2019 issue
CEO SUMMARY: At MD Anderson Cancer Center and Baylor St. Luke’s Medical Center, blood transfusion errors led to two patients’ deaths in separate incidents last fall. Then, this spring, a patient died in the emergency department of Ben Taub Hospital following “an ineffective process in patient monitoring and communication of critical lab values.” State and
Bill Would Delay PAMA Reporting for One Year
By Joseph Burns, from the Volume XXVI No. 10 – July 22, 2019 issue
CEO SUMMARY: For all laboratories that must report private payer price data under the Protecting Access to Medicare Act (PAMA), a new bill in congress would delay the next round of data reporting for one year and require the National Academy of Medicine to recommend ways to improve the data collection and market-rate setting processes
Houston Errors Are Every Clinical Pathologist’s Fear
By R. Lewis Dark, from the Volume XXVI No. 10 – July 22, 2019 issue
Due to medical errors, three patients died in three Houston hospitals in a short period of time. Each adverse event led to inspections by the federal Centers for Medicare and Medicaid Services (CMS) and sanctions as tough as revocation of deemed status for participation in the Medicare program.
That these events came so closely together, at
July 1, 2019 Intelligence: Late Breaking Lab News
By Robert Michel, from the Volume XXVI No. 9 – July 1, 2019 issue
In Houston, news outlets report that MD Anderson Cancer Center was cited for serious deficiencies and the potential for patient harm, following inspections by officials from the federal Centers for Medicare and Medicaid Services (CMS) and the Texas Department of State Health Services. After an adverse patient event involving transfusion services that occurred in December,
Aetna Ends Payment for Professional Component
By Joseph Burns, from the Volume XXVI No. 9 – July 1, 2019 issue
CEO SUMMARY: As of Aug. 1, Aetna will stop paying out-of-network pathologists for the professional component review of certain clinical pathology tests. Until now, the health insurer has paid for the professional component when out-of-network labs billed for clinical lab tests using the modifier 26. In a notice to labs, Aetna said it will pay