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pass through billing

DOJ Indicts Ten Individuals for Pass-Through Lab Test Billing Fraud

PASS-THROUGH LAB TEST BILLING SCHEMES involving rural hospitals and $1.4 billion in fraudulent lab test claims are at the core of multiple indictments announced recently by the federal Department of Justice (DOJ). Ten individuals—including laboratory owners, billing company…

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Anthem Alleges $16M in Calif. Hospital Lab Fraud

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 la…

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Rural Hospital Group Says Lab Billing Model Is Legal

CEO SUMMARY: In recent years, many rural hospitals have entered into agreements to expand their laboratory outreach businesses. In an interview, the president of the National Association of Rural Hospitals said rural hospitals often bill for lab outreach services under Medicare’s 70/30 …

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Attorney Explains 70/30 Rule, Pass-Through Bill Arrangements

HOW THE LAB OUTREACH BUSINESSES of rural hospitals originate lab specimens and bill for lab tests is getting increased scrutiny. The reason for this rise in interest is that a growing number of rural hospitals are generating almost as much revenue from laboratory outreach testing as they get from all…

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Rural Hospital Spokesman: Hospital Lab Outreach Programs Are Legal

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…

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Why Lab Companies Buy Bankrupt Rural Hospitals

CEO SUMMARY: Seeking the higher lab-test payment rates that insurers pay hospital labs, some lab testing companies are buying rural, financially-struggling hospitals in what may be the latest twist on the pass-through billing strategy that certain lab testing firms have found to be lucrat…

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Lab companies and bankrupt hospitals: Dancing around medical billing fraud

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. …

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May 29, 2018 Intelligence: Late Breaking Lab News

Ireland is dealing with a cervical cancer screening scandal that reaches back to laboratories in the United States. In recent months, the Irish public has learned that more than 200 women wrongly got negative Pap test results over a multi-year period. Many of these women did not learn of the erroneo…

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Insurers Sue To Challenge Pass-Through Bill Schemes

CEO SUMMARY: In two separate lawsuits filed in April, UnitedHealthcare (UHC) and Anthem each charged that drug testing companies used pass-through-billing schemes in ways the insurers say are fraudulent. UHC filed its lawsuit on April 18. One day later, on April 19, Blue Cross and Blue Sh…

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May 7, 2018 Intelligence: Late Breaking Lab News

In Sebastopol, Calif., the financially-troubled Sonoma West Medical Center (SWMC) dropped a controversial drugs-of-abuse testing program. The following month, without the revenue from the drug testing program, 37-bed SWMC lost $1.4 million. In 2017, the hospital entered into a pass-t…

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