G-2 Compliance Report
G-2 Compliance Report is designed to guide hospital, lab, and pathology professionals in developing, implementing and revising compliance programs to meet federal standards. In every issue, you’ll get practical advice and information you need to: Stay on top of fast-changing federal mandates Structure business arrangements to prevent fines Reduce exposure to whistleblower lawsuits Maintain public trust and thwart negative publicity And more With the continued emphasis on healthcare fraud by the Justice Department and HHS Office of Inspector General —and record-setting fines and settlements—don’t take the risk of being caught unprepared for an investigation and audit.
June 2008 - Table of Contents
A federal district court May 5 vacated a preliminary injunction order blocking the Centers for Medicare & Medicaid Services from enforcing a provision in an anti-markup rule that would have made substantial changes to the way physicians bill for anatomic pathology diagnostic testing services (Atlantic Urological Associates PA v. Leavitt).
Health care providers who resolve fraud matters using the Department of Health and Human Services Office of Inspector General’s (HHS OIG) provider self-disclosure protocol generally will no longer be required to enter into corporate integrity agreements (CIAs).
In its final report on gaps in the oversight of genetic testing, the Health and Human Services Secretary’s Advisory Committee on Genetics, Health & Safety (SACGHS) has urged the Centers for Medicare & Medicaid Services (CMS) to increase proficiency testing in this rapidly expanding market. The panel also recommended that the Food & Drug Administration (FDA) expand its regulation to all lab tests, including lab-developed tests (LDTs).
The Centers for Medicare & Medicaid Services (CMS) has issued a revised Advanced Beneficiary Notice (ABN) that clinical laboratories and other providers billing Part B must use by no later than September 1 of this year.
Before the Clinical Laboratory Improvement Amendments of 1988 (CLIA) took effect in 1992, significant numbers of primary care physician office laboratories (POLs) performed tests that are now classified as moderate and high complexity. At that time, no quality requirements existed for POLs and reimbursement for lab tests was generous in comparison to today, since managed care was virtually nonexistent and Medicare fee cuts and freezes had not yet begun.
The Centers for Medicare & Medicaid Services (CMS) is revisiting a controversial provision it finalized in the Phase III Stark rule in 2007 that requires doctors with financial interests in physician organizations to "stand in the shoes" of those organizations for the purpose of complying with the physician self-referral law.
Genetic Anti-Discrimination Bill: President Bush is expected to sign into law legislation protecting patients from discrimination based on their genetic information. The legislation, H.R. 493 as amended, cleared Congress May 1. The measure bars employers from using genetic information in decisions on hiring, firing, job placement, or promotion. It prohibits group health plans and other health insurers in both the group and the individual market from using genetic information to deny coverage or set premium…
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