Call it the enforcement "flavor of the month," but laboratories have been feeling the heat from federal investigators recently, particularly those interested in their relationship with physician practices, which may run afoul of the anti-kickback statute.
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Two years after federal agents arrested David and Scott Nicoll, owners of Biodiagnostic Laboratory Services Inc. in New Jersey, for orchestrating a 37-person, $200 million fraud scheme, CNBC is pulling back the curtain on how that scheme evolved.
More than $120 million in improper billing activity has taken place in Georgia over the past week. On Monday, a hospital settled allegations from federal prosecutors that it violated the False Claims Act by cutting a check for $20 million. Meanwhile, Centers for Medicare & Medicaid Services officials want the state's Medicaid program to return $100 million in overpayments to nursing homes.
Home healthcare aids represented 30 percent of the criminal convictions by Medicaid Fraud Control Units in 2014, according to an Office of Inspector General report. This marks a slight increase from 2013 and remains well ahead of any other provider type.
Federal investigators have seized more than $100 million from the owners of 1-800-GET-THIN, the intensely marketed and highly popular company that provided Lap-Band weight-loss surgery. The seizure, which has been criticized by defense lawyers, is part of an ongoing investigation into the company's billing practices.
At least six whistleblower lawsuits have been filed in states across the country alleging overpayments linked to privately run Medicare Advantage plans, and more are expected to emerge.
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The newly formed Center for Healthcare Transparency has an ambitious goal--it wants half of the U.S. population to have access to reliable cost and quality information by 2020. But panelists at Friday's event to unveil the new initiative at the National Press Club in the District of Columbia said the healthcare industry's current transformation make now an ideal time to pursue such an effort.
Patient treatment selection, health policy development and hospital performance evaluation efforts all are impacted negatively by poor data monitoring and reporting via the use of "substandard" clinical registries, according to research out of Johns Hopkins University.