2.1 Billion Genetic Testing Fraud

The Department of Justice (DOJ) charged 35 people for fraudulently selling unnecessary medical tests to thousands of elderly patients who were using Medicare. This ultimately cost Medicare 2.1 billion. Those charged worked for a variety of telemedicine and cancer genetic testing laboratories (CGx). MedTechDive reported that CMS took administrative action against CGx testing companies and providers who filed more than $1.7 billion in Medicare claims.  The HHS Office Of Inspector General put out a warning to the public back in...

A Cry For Industry Reform: $760+ Billion Dollars Wasted Annually

For every $4 spent on healthcare, it is estimated that $1 is being wasted. When put to scale, that 25% equates to a tremendous sum of $265 billion dollars annually. Spearheaded by the health insurance company Humana, these numbers shed light on how dire nationwide reform is for this industry.  As healthcare costs continue to rise, the last thing that the American people want to hear is that their dollars spent on health insurance are being wasted, but in many...

CMS To Raise Fees For The First Time In 20 Years

For the first time in nearly two decades, CMS is having to raise their fee in order to remain self-sustaining as required by the law. This fee will apply to all laboratories certified under the Clinical Laboratory Improvement Amendments (CLIA). Labs will be required to obtain CLIA certification prior to being able to perform testing.  With significant growth being experienced since 1992, this fee increase will help maintain CMS through the year 2021, allowing them to continue to offer leading...

Raise And Restructure Your Lab’s Position For System-Wide Success

The health industry has been placing more importance on value over volume, and patient outcomes are overriding revenue as an indication of achievement. To keep up with the shift, lab leaders need to broaden the lab’s ability to support value-based strategic objectives, according to Becker’s Hospital Review. By creating value across all programs, the lab can be positioned as a leader of the health system.  To do this, it is important to understand how the lab impacts the system’s strategic...

Ohio is Leading the Charge in Successful PBM Integration Through the State Medicaid Program

House and Senate leaders in Ohio are establishing a system that has the potential to offer a significant change in the state’s Medicaid program. They are leading the charge in this change by hiring a pharmacy benefit manager, also known as a PBM. The PBM was chosen by the state’s Medicaid department with the hopes of cutting out the middleman and providing a more transparent view of the state's current financial landscape in terms of drugs, pharmacies, reimbursements, and more....