2 Laboratories Pay $48.5 Million to Settle Anti-Kickback Claims

According to a recent Department of Justice press release, two cardiovascular testing laboratories – Health Diagnostic Laboratories (“HDL”) and Singulex – recently entered into a settlement agreement for a combined $48.5 million.   The settlements resolve a qui tam complaint which alleged that HDL and Singulex violated state and federal anti-kickback statutes and false claims acts and submitted claims to government and private insurers for “medically unnecessary” services. The settlement was the result of a whistleblower lawsuit which alleged that the… Read More >

Improper Management Agreements Serve as Basis for $10 Million Dollar Settlement

The Department of Justice (DOJ) released a statement on March 31, 2015 discussing a recent settlement agreement with Robinson Health System, Inc., based in Ohio. The settlement arose from allegations that the health system had violated both the Anti-Kickback Statute and the Stark self-referral prohibition by entering into management agreements with physician groups who allegedly did not provide sufficient bona fide management services to justify the amount of the payments. This settlement is a good reminder to physician groups and… Read More >

OIG Says Waiver of Laboratory Fees Could Violate Anti-Kickback Statute

In OIG Advisory Opinion 15-04, the requestor, a multi-regional medical laboratory proposed to enter into agreements with physician practices which would allow the requestor to provide all laboratory services for the physician’s patients. The requestor indicated that physicians desired such a relationship because it would provide for better communication and consistency (e.g. consistent reference ranges and interfaces). The current barrier to such a relationship is the requirement by certain “Exclusive Plans” that labwork be sent only to certain designated laboratories… Read More >

CMS Announces April 2015 Release of Ophthalmology Comparative Billing Report; Upcoming Webinar for Modifier 25: Nurse Practitioner Comparative Billing Report

CMS recently announced that it will issue a Comparative Billing Report (CBR) focused on ophthalmology providers in April 2015. Pursuant to the March 19, 2015 MLN Connects Provider News, the CBRs will be produced by CMS contractor eGlobalTech, and will “contain data driven tables and graphs with an explanation of the findings that compare these providers’ billing and payment patterns to those of their peers” both across their state and nationally. The CMS announcement does not indicate which ophthalmology services… Read More >