List of Labs with hospital billing schemes

Since have all been screwed by these distributors. Let's start listing labs with hospital billing schemes with the distributors name as well.

 

Sutter Health Scam
MEdoc Scam
Gulf Labs Scam
Southwest Labs Scam
Millenium Scam

 

None of these are really scams perse. The above found a loophole, and used the loophole. Instead of the insurance companies recognizing and trying to close the loophole, they will make the above individual lives hell. This loophole exists as most hospitals are unable to read many pathology samples, and hence use outside labs to run these samples for then. Examples would include cancer pathology samples etc.

Btw, the above pathology samples cost just as much as a Pgx test. The difference is that the pathology samples are run by big name politically affiliated academic institutions (rhymes with Yayo).

Also, many of the same people/institutions that have a hand in insurance exchanges have there hand dipped heavily in the big lab world.

Then you have independent labs, that also want to profit like the big players, but for them the rules are much different. They are not politically connected and hence consequences are different. So these labs are charged with insurance fraud and owners/reps/doctors are indicted while the big labs take all the business.

Same thing happened with compound pharmacies when they started messing with big pharma, and the same thing is happening to these labs. My advice is to get out and wait a few years for the system to self implode. Which it will soon. Anthem and united are both pulling out of the exchanges. Doctors are leaving Medicare and the Managed Care model. I think is 2 years, the tune will be much different.

 

http://www.fiercehealthcare.com/finance/state-auditor-rural-missouri-hospital-used-as-shell-for-90b-fraud-scheme

 

You are missing the big stinking fly soaked boat. Most abuse is happening in the offices between labs and practitioners and their office managers. Bilkling medicare. kickbacks for specimens. ridiculous draw fees to offices even though they have a labcorp phlebotomist on hand who draws for all patients even if they are not labcorp. splitting bonus and kickers with offices for increasing send outs. buying equipment and "gifts" for doctors and their staff. sponsoring holiday parties for staff so doctor doesn't have to pay out of pocket. The list goes on and on... scum buckets.

 

And lest we forget the favorite - "not collecting" copays and co- insurance from patients.

 

Are you Jelly?

 

Hold up there one second. You must bill for co-pays and deductibles REGARDLESS if you are In-Network or Out-Of-Network. HOWEVER, you are not forced to send anyone to collections or report it if you are Out-Of-Network as all that means is you have NOT signed a contract with that insurance carrier.

In other words, you have to follow the legal guidelines but you do not have to follow any rules that the insurance carrier may normally force labs who signs a contract with them to do.
Some insurance carriers have plans that have deductibles and others do not (most do) and almost every plan has co-pays regardless if the patient has work done at an In-Network Lab or Out-Of-Network lab just as they do if the patient sees an In-Network physician or an Out-Of-Network physician.

Every plan has OUT OF NETWORK coverage which means that of course your physician can use an out of network lab if they want to and there is absolutely nothing the insurance carrier can do legally to force any physician to strictly use an In-Network lab otherwise they would be setting themselves up for a HUGE lawsuit. Just remember that it is the physicians medical license on the line not the insurance carrier and if they want to use an out of network lab then there is nothing that insurance carrier can do to the physician if they are willing to have some balls and stand up to the carrier if they give them any heat about it.

 

The technical term for these programs is "outreach." HOPD stands for hospital outpatient department. In my experience people who refer to these programs as HOPD don't understand what's going on. Any hospital executive would laugh if you called their outreach program HOPD.

Properly run Hospital Outreach programs are not new, nor are they "shady." It's extremely common place for physicians to send their lab work to a local hospital. Additionally it's the standard, and expected, when you're employed by a hospital. Most everything regarding outreach is spelled out in the Medicare Claims Processing Manual. There's also specific language in the Managed Care contracts between payors and hospitals that needs to be looked at. Some permit the practice, others do not.

https://www.cms.gov/Regulations-and-Guidance/Guidance/Manuals/Internet-Only-Manuals-IOMs-Items/CMS018912.html

There's a right way to do these, and of course, as we've seen time and time again, a wrong way. The fundamental issue with nearly all these programs is that these independent laboratories have been engaging in Under Arrangements with all these hospitals. In other words, an independent lab was processing the specimen and then billing "under an arrangement" through the hospital contracts. While this is not explicitly prohibited by CMS, most managed care contracts prohibit the act.

Read the Campbellton Graceville lawsuit. Read the Mission lawsuits. The basis for their claims of fraud is that the testing was never performed at the hospital.

Just like any lab there's nothing wrong with a hospital going out and hiring a sales team to sell doctors on their laboratory. It's been going on for years, and will continue to do so into the future. Some overly aggressive people got greedy and did things the wrong way and unfortunately gave a bad name to an old, compliant and profitable business practice.

Just take a look at the news. Quest and Labcorp have been buying up outreach programs for awhile now.

http://newsroom.questdiagnostics.com/2017-09-29-Quest-Diagnostics-Completes-Acquisition-of-the-Outreach-Laboratory-Services-of-Two-Hartford-HealthCare-Hospitals-in-Connecticut

http://www.businesswire.com/news/home/20170110005755/en/LabCorp-Acquire-Assets-Mount-Sinai-Health-System

There are good eggs out there. And you can make an outstanding income working with the right program. Just do your due diligence and make sure you're not working with any program utilizing under arrangements (not performing work at the hospital), taking specimens too far away from the hospital and keeping the charges realistic.

 

Why don't you just provide your contact info in your original post you turd.

 

The difference is cancer labs, not the BS cologaurd screen junk, have no 1099 reps, follow the "do no harm" model, don't run unnecessary tests just to take advantage of a loophole in coding, and provide real actionable information tied directly to a companion diagnostic drug. You are a fool if you compare the tox/PGx scam to the legitimate cancer diagnostic field. Oncologists are not thieves like pain doctors, the labs that rhyme with Yayo use the TC/PC model, which is legit. Tox and PGX are a joke, a total scam, just like the compounding scheme, total black market trash. Thats why no "real" lab will hire you, because they know you have no moral compass, no ethics, no desire to help, you are just a cash grab short term thinker.

 

Lol... why don’t you start by first investigating yourselves for underpayment to physicians. Or how about slow pay/no pay. You work for the biggest peice of crap insurance company in the states right now. The fact that you have a job is more proof that BCBS is piss poorly managed. There is nothing ethical about about what you do.

 

Hey b itch boy. You going to respond? You work for the biggest fraudlant company of all time. Talk about it B itch boy!

 

Are you only interest the Hospital billing schemes? How about all the kick backs in pathology?

 

Nothing truer has been said. Screw you BCBS

 

Go see what is happening over at Life Brite and the games reps like, Dwane Pope are playing

 

Don’t make me laugh BCBShit are you serious???? Yes, specialty lab reps that are losing by these hospital scams are pissed and want to put it to an end but helloooooo
YOUR dumbass insurances of states A thru z don’t play in the sandbox and contract with any specialty lab. Only LabCrap and Quest(ion mark) why should of us help YOU when you allow these monopolies to eat out lunch? Insert tail back between your legs.

 

I'm with Humana Special Investigations and I'm very interested in learning about any fraudulent or unethical schemes that involve laboratories and hospitals.