OMG it's the OIG

It's really coming, this time. Reliable water cooler chatter says the piss-hammer is about to land on Millennium with a thud that will obscure all previous settlements in this space. Only question now is if King of Pain Slattery has enough bank left to buy his way back into CMS.

 

I've heard from a reliable source that the river of money that used to flow to Millennium has not only dried up, but that multiple insurers are demanding rebates for over-payments and unnecessary testing.

 

I'm hearing big, big money. Like $125 million fine. ouch. that's gotta hurt

 

It that is all the fine is, then they made the right move with their business plan. Net profits still intact. No personal forfeiture of houses, planes or cash.

http://www.kitsapsun.com/news/local-...rate-hangar-at

 

When can we expect some formal news on this?

 

soon. next week....

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Could this potentially put the company out of business or just put a large dent in the bank account?

 

It depends on how dirty the investigation and trial end up being. There are so many competitors in this space now that customers will jump ship if they think they're working with a dirty lab and might be deposed or have to testify in a big court case.

And don't forget, next year Tox is taking a huge haircut with coding changes and limits to the number of tests being run. That could put Millennium out of business by itself...

....

 

Best case scenario it is a fine only and a corporate integrity agrement. Worse case is that we can no longer bill any federal insurance plans - Medicare & Medicaid. Then it is over.

 

What about the huge for profit insurance cos? like wouldn't a united or aetna want payback for false billings too? what's that saying, a hundred million here, a hundred million there and pretty soon it starts to add up to "real money."

 

Anyone heard of any labs that r hiring?

 

OIG is just the start

 

Medical Biller:
The big carriers, especially BC/BS, will deny payment if they haven't already and at some point make demands for a refund. There are divisions within insurance carriers who audit providers as well as evaluate excessive utilization of specific CPT codes. They are not looking for suspected over-utilization but also for situations where they paid claims they shouldn't have or overpaid them due to unbundling or using outdated codes that pay higher.

Additionally in an audit they will try to determine if patient responsibilities for co-insurance and deductibles were routinely waived.

 

And they can go back as long as they like!

 

We can hope this is so:

"The wording of the CID letter and the information requested certainly makes me wonder if the DOJ is also going after the referring physicians as well, and not just MH."

"The DOJ told the physician its primary areas of inquiry were:

1. Submission of claims for UDT services and reimbursement for those claims;
2. Medical necessity of UDT generally and for specific patients;
3. Ordering of UDT, including, but not limited to, the documents and forms used to order UDT;
4. Sales practices concerning UDT directed towards you or the entities for which you work, including, but not limited to, promises or provision of free goods and services; and
5. Remuneration by urine drug laboratories to you or the entities for which you work

The documents requested and interrogatories also provide additional insight into the government’s investigation. Among the documents requested were:

• All contracts and agreements including custom profiles and/or standing orders
• All documents concerning payments or other remuneration (including meals, staffing assistance, discounted equipment, assistance with CLIA certifications and electronic medical records, and speaker fees)
• All documents concerning waiver of co-pays by MH
• All documents submitted to MH including requisition forms, custom profiles, and standing orders
• All documents concerning medical necessity of UDT, including confirmatory or quantitative testing of negative UDT screen results performed at the point-of-care
• All patient records and billing files for eleven patients listed

The interrogatories demanded even more information:

• State whether you have obtained a Certificate of Waiver under CLIA
• Describe the nature of UDT you perform pursuant to the Certificate of Waiver
• Describe the nature of any moderate complexity UDT you perform
• Describe the nature of any high complexity UDT you perform"

http://pathologyblawg.com/pathology...ail&utm_term=0_d76ed06817-302f3d1467-64526673

 

When will we see the impact in the field? Layoffs, etc... Also, have we heard what the final fine is to CMS?

 

Only the beginning. BC/BS, Aetna, Cigna, etc. will now take claw backs too. Too bad we thought we had "found" a legal way to print money.

 

The "we don't collect co-pay and take what we get" they started will come back to haunt them. It was used by a lot of followers. Private payers are on this and are "clawing". PR sends out a "we have settled" message but nothing is settled from the loan to their improper billing and promotional activities already deemed illegal in the Ameritox lawsuit. Medicare needs to decertify.

 

There was a legal way. Your leadership decided to not follow the law and flaunted it in such a manner that this has been coming for a long time.

 

And the doctors using their services were complicit with this. Too bad the most egregious of them are not looking at handing the government back some of the money that is not theirs to keep.