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April 24, 2015

Today's Featured Story

Lab Compliance Takes Center Stage as Cases, Guidance Come Rolling In
Reprinted from Report on Medicare Compliance

About 20 years after the federal government cracked down on lab billing, there is now a renewed focus on labs and their relationships with physicians. “Labs are where health care fraud enforcement started in the early 1990s and it spanned the entire decade,” with the national crackdown on lab unbundling that recovered $1 billion, said Washington, D.C., attorney Karen Lovitch, who is with Mintz Levin. The government then turned its attention elsewhere — to big pharmaceutical and medical device cases, for example — “but we have seen recently that labs are starting to get more enforcement attention than they have in a while,” said Lovitch... Read Full Story


Quote of the Day

There are “a lot of folks inside CMS who just think if you are serving a lot of vulnerable beneficiaries, low-income duals, then you just need to work harder and need no special treatment.”

— John Gorman, executive chairman and founder of Gorman Health Group, LLC, told AIS’s Health Plan Week for a story on CMS’s final 2016 Medicare Advantage payment rates.

Click here to read the HEALTH PLAN WEEK article in which this quote appeared. (Free for HPW subscribers; $17 for non-subscribers).


Today's Datapoint

6 million ... individuals will be enrolled on private health insurance exchanges for the 2015 plan year, marking an annual growth rate in excess of 100% since 2013, according to a recent report from Accenture.



Today from Washington

People on the Move

Vanda Pharmaceuticals Inc. appointed Tom Gibbs senior vice president and chief commercial officer. Gibbs was previously vice president of worldwide commercial operations at Bristol Myers Squibb....Samantha Dawkins joined PruittHealth as vice president of communications. She was formerly global brand director for Caesars Entertainment....Bankers Healthcare Group named Joe Valeo executive vice president of outside sales. Valeo was most recently EVP of national sales for Capital Access Network....Convergent Revenue Cycle Management, Inc. promoted Senior Vice President of Sales and Marketing Mark Schanck to company president.


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