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Medicare Pays 500% More for Molecular Test Claims

In some states between 2018 and 2019, Medicare paid 500% to 700% more for some genetic tests

CEO SUMMARY: Rapid growth in what Medicare spent for molecular tests in recent years may lead federal investigators to increase scrutiny of fraudulent billing for clinical laboratory and molecular pathology tests, according to a lab consultant who has tracked such spending in recent y...

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DOJ $6B Fraud Crackdown Charges 345 Defendants

Largest enforcement action in department history also ensnares molecular and drug-testing lab firms

CEO SUMMARY: Department of Justice cases involving clinical labs or molecular test claims may represent about half (or about $3 billion) of the total fraudulent claims. Those claims stem from genetic testing, urine-drug and other tests, and healthcare services, the DOJ said. In additi...

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High-Complexity Mobile Labs for COVID-19 Testing

Company offers on-site testing with fast results for employers, sporting events, concerts, and more

CEO SUMMARY: Demand for high-complexity mobile coronavirus testing facilities is high, according to the CEO of a start-up company building 25 clinical labs in mobile trailers that can do hundreds of tests per eight-hour day. Employers, schools, event organizers, and other entities all...

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LIS Update LIS and Lab Informatics Vendors Report Second Quarter Earnings

During one earnings conference call, a CEO described labs’ growing interest in moving their LIS to the Cloud

IT'S BEEN A CHALLENGING YEAR for companies that sell laboratory information systems (LIS) to the nation’s clinical laboratories. Because of the SARS-CoV-2 outbreak, labs have delayed decisions to acquire or upgrade their existing LIS systems, as well as previously-scheduled installs of new o...

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Lab Regulatory Update UnitedHealth Sets More Billing Rules for Labs, Pathologists

UHC seeks refunds for some prostate biopsies and requires member consent for out-of-network referrals

SUBMITTING CLINICAL LABORATORY AND PATHOLOGY TEST CLAIMS to UnitedHealthcare (UHC) will be more complex after the nation’s largest health insurer announced three significant changes in its claims processing procedures. The three changes involve: • Requests for refunds from anatomic pa...

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Lab Finances to Become More Challenging

When you finish reading our story about how Medicare spending for molecular and genetic tests jumped by as much as 700% in certain states during 2019, you’ll be among the first in the nation to understand why a financial crisis is soon to wash over those clinical laboratories and pathology groups that perform genetic tests. We thank Bruce Quinn, MD, PhD, principal ...

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Don’t Be at the Mercy of the Tumultuous Healthcare Revolution

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