Fraud and Malpractice in Dallas Leaves Healthcare Executive Sentenced to Time in Prison

Andrew Hillman, former co-owner of Next Health LLC in Dallas, Texas, pled guilty to defrauding the government and private insurance through a phony “wellness” program. Hillman also pled guilty to a separate physician kickback scheme in which doctors were paid to refer patients to the latently-closed Forest Park Medical Center (FPMC).  Though clinical laboratories were the fulcrum of the Next Health money laundering scheme, it involved layers of shell companies, limited liability companies (LLCs), and umbrella corporations to shield each...

Lab Offshore Billing Could be Costly in the Long Run

Attempting to cut costs of clinical laboratory test billing, a number of labs and pathology groups have moved billing and collections to overseas companies. These companies are charging nearly half of what American billing companies charge; yet, along with the cheaper rates the groups are experiencing a sharp drop in revenue - up to 30-40% or more.  This decline in revenue is due to the fact that most of these offshore companies may not resubmit rejected claims or go after...

$150M Dallas Laboratory Fraud Case

Former co-owner of Next Health LLC, Andrew Hillman which included a network of drug and genetic-testing labs based in Dallas, plead guilty on charges of violating deferrals anti-kickback laws. He plead guilty to this Dallas laboratory fraud case in 2018 and has been sentenced to 66 months in prison and required to pay $3 million in restitution for his role in fraud, doctor kickbacks, bribery, and money laundering. Owners Andrew Hillman and Semyon Narosov pleaded guilty to accounts of medical...

RWJBarnabas and Rutgers University Unite for a Common Goal

Negotiations involving hospitals and health care systems often take years - this forces patients to wait for potential benefits to be realized. Should this be the norm in an industry that is in dire need of transformation and disruption? When RWJBarnabas Health began pondering the idea of a partnership with Rutgers University, New Jersey was falling behind other national leaders in funded research, which ultimately meant fewer options for patients and difficulty entreating the best physicians to stay. The two...

Progress is Made on Value-Based Payment Models

The transformations in healthcare have payers and providers on somewhat divergent paths when it comes to key issues, such as how each sees their role in value-based care and how they should be meeting the rising expectations of patients. For Instance, 43% of providers say they derive less than 10% of their revenue from these specific payment models, while only 21% of payers stated the same. When it comes to what is hindering progress towards value-based care, providers are much...

Clinical Lab and Anatomic Pathology Leaders Face 2020 Challenges

The ongoing and reformative changes in the American healthcare system are triggering tough challenges for leaders of the nation's clinical laboratories and anatomic pathology groups. There are two basic pillars to the nation's healthcare reform, one is the integration of medical care to keep people out of hospitals - which are the most expensive sites of care - and to further proactively manage current patients to keep them healthy.  The second is a change in reimbursement structuring, policymakers in 2020...