You will know us soon enough. We have a contract with BCBS of Florida. Do you?
Stone Clinical Diagnostics
- Thread starter Lonestargirl
- Start date
Stone will do well in the panhandle. Docs are excited. Would not mind being a rep for them in Florida.
The docs are excited. They are tired of LC and Quest. They want another option. They love the fact that Stone will be local. When we win don’t come crying for a job. We don’t need or want you.
“A” start-up? I said “your” start-up, but now that you’ve expanded the discussion – yes! Virtually every crappy tox/PGx/CGx/Inf Dis lab arise from easy market entry, money-grab from a growing sector and exit strategy of be acquired for 3-5 times EBITA.
On this we agree 100%. The difference with Stone, when compared to other startups, is that they have managed care contracts. The company has done a great job of securing in-network agreements. With continued increases in volume, the company will see positive increases in revenue. The Florida Blue contract is valuable. When the company takes market share in the Panhandle the bigs will come calling.
this is one of the dumbest replies I have read on this site (and that says something). Real ambition is becoming an executive at LC or Q?!? Ask the execs at either company. They will tell you the place to make the most money is a startup. It is also more exciting because you are not working for a publicly traded organization. You have a greater say and can be creative. I know you are scared of Stone taking market share. Don’t be a cafepharma clown.
Well then, your reading comprehension compares with that of the rest of your crappy lab. I didn't say ambition for everyone was exclusive to Quest and LCA. For example. You seem ambitious, but its limited if you're still working for Stone. Ambition, nonetheless.
Speaking of dumb ... do you really think officers of Quest Dx or Labcorp would trade places with a start-up tox lab? Absurd. Look at any CEO or SVP of a tox start-up. They're either big-box flunkies, washed up or the greedy (or as you would say, shady) quasi business ilk.
No possible way you can make more money in a start-up, especially considering the risk and financial out-lay. Not in this sector within the past 10 years. The “excitement of a start-up lab” is only a childish notion sold to followers like you.
Stone is not a tox lab. Second, with the in-network agreements that stone has landed, members of their senior executive staff are 100% interested in joining the team. I have interviewed two. Third, the labs crushed over the last 10 years were often ngs companies conducting tests that were not covered or specialized in only one area (tox). Stone runs tests that have medical policy and in-network contracts assure payment. Very rarely do we have issues with non payment. Finally, the BCBS Florida agreement is a winner. You are correct. I am ambitious. I believe in our team and stone. I am happy to be a part of this success story.
What arrogance. You speak as if Quest and LCA do nothing wrong and never break any laws. Both organizations are sort of shady too and hide behind their lobbying arrangements, bureaucratic contracts, massive legal teams, and their ability to engage in predatory pricing by discounting to private insurance payers while molesting and manipulating Medicare/Medicaid plans. Without their sheer might and back door deals, they could never legally operate these business models.
Quest and LCA quietly pay more in fines every month than all these outlier startup labs combined take in during an entire year.
You just go back to your corporate job, with your useless title, and keep contributing to our realization of national "healthcare for all".
I’m not convinced that the poster is arrogant. I think they are scared. They know change is coming.
I forgot to include how both companies offer low ball client pricing directly to higher volume physician accounts, allowing those practices to engage in pass through billing to private PPO plans and for cash paying patients (with a modest profit margin) - in exchange for ALL of their Medicare/Medicaid/contracted private plan referrals.
There have been DC Congressional and House inquiries about this practice for years - and it isn't it strange that they continually go nowhere.
Why is that Mr Big LCA Executive guy?
If this is Chris, then you have balls as big as Texas to come to a forum like this to defend your company. That said, it’s commendable and speaks to your leadership.
“Not a tox lab.” Like other small labs that offer tox, other testing has been included. Smart move for this sector, but my guess is that tox keeps your lights on.
Yes. Local legacy lab in-network agreements are an advantage and hard to come by with small labs. Labs that are completely out of network will be eliminated by leakage efforts.
You might be taking liberty with the term “executive team.” This is at least a regional VP. But I would argue that 100% interest would include their recruitment. Doesn’t look like that happened
The start-up labs that haven’t made it or on the bubble are those just like yours. Most start-up, mature start-ups and even the 20-year veterans in this sector are struggling. Hence the sector contraction and consolidation.
Lastly, body shaming bullying is not going to ingratiate anyone to your self-declared success story. Even a tacit nod to this behavior is abhorrent.
The accusation of Stone being “shady” came from one of your supporters. With the risk of sounding arrogant, you might want to keep up with the thread.
“Hide behind their lobby arrangements” What arrangements are they hiding behind? Big companies have lobbyist looking out for their business’s interest. Labs? Mostly related to PAMA and EKRA recently.
“Hide behind bureaucratic contracts” What contracts? Government RFPs which often require services only large labs can offer?
Massive legal teams? Either lab has 50,000 employees! Stone has 50. Per employee, Stone has more legal representation.
“Predatory pricing, molesting federal plans” … Whoa Nelly!! Reel it in. Winning private insurance contracts with discount pricing is the advantage of being a large lab with lower cost of testing. Equally important, Insurance companies are looking for value-based data, standardized connectivity and vendor relationships for quick interfaces, patient access, a full test menu and other specialized services not found in a lab like Stone.
“Back door deals” Is this a Stone talking point? Is this how you sell against the two major labs? Both labs have had Corporate Integrity Agreements (regular compliance training) with the federal government since the early 1990s. No sane big-box executive flirts with non-compliance.
What fines are they quietly paying? EEOC? Billing related? What the frick are you talking about? Has their legal team settled on dispensing payments for any reason? YES! 50K employees, that’s gonna happen!
You mean lower pricing than yours. Pass through billing markets minimal, but they competitive and it’s usually the smaller labs (under the OIG radar) who take chances with below cost of testing/below fair market value pricing. The compliance teams at both labs would not let pricing go through if it’s not 20-30% above cost of testing. Cost of testing is lower with large labs based on fundamental principles of economics. Although you implied an anti-kickback infringement, there is no inducement if the physician pricing is above cost of testing.
"There have been DC Congressional and House inquiries about this practice for years - and it isn't it strange that they continually go nowhere. Why is that Mr Big LCA Executive guy?"
I don’t work or speak for Labcorp, but the big box labs have no interest in pass through billing markets. It’s only an advantage to small labs where pricing is the only value they can offer. The lobbying efforts are coming from the physicians who stand to lose a revenue stream – some substantial. Network physicians are far more important and have far more pull than vendors.
There are pages and pages of this for those who care to look.
It continues today - and the process just goes on and on.
Attorney General Kamala D. Harris Announces $49.5 Million Settlement with Labcorp
August 31, 2011 at 6:34 PM
August 30, 2011
SAN FRANCISCO -- Attorney General Kamala D. Harris today announced a $49.5 million settlement with Laboratory Corporation of America, the state's second largest provider of medical laboratory testing, stemming from a lawsuit alleging illegal overcharges to the state's medical program for the poor. The settlement with Labcorp will bring the total recovered so far in the Attorney General's lab test pricing cases to $298 million.
"Medical providers and professionals who attempt to abuse Medi-Cal are draining healthcare resources from the millions of California families and children who rely on the program," said Attorney General Harris. "In this time of difficult public budgets, we will make it a high priority to track down those who engage in excessive charges, false claims or illegal kickbacks of Medi-Cal funds."
The settlement with Labcorp is the result of a lawsuit filed under court seal in 2005 by a whistleblower and referred to the Attorney General's office. The lawsuit alleged that Labcorp and other medical laboratories systematically overcharged the state's Medi-Cal program for more than 15 years and gave illegal kickbacks in the form of discounted or free testing to doctors, hospitals and clinics that referred Medi-Cal patients and other business to the labs.
In May, Attorney General Harris announced a settlement of $241 million with Quest Diagnostics for the same alleged practice.
According to the allegations in the lawsuit, Labcorp charged Medi-Cal over five times as much as it charged some other customers for certain tests. For example, Labcorp was accused of charging Medi-Cal $35.04 to test for total testosterone, while it allegedly charged another customer $7.36 for the same test.
Under the state's False Claims Act, any person with previously undisclosed information about a fraud, overcharge, or other false claim can file a sealed lawsuit on behalf of California to recover the losses, and is entitled to a share of the recovery in some cases. Such individuals become plaintiffs and are known as "whistleblowers," "qui tam plaintiffs," or "relators."
In this case, the whistleblowers were Chris Riedel and his company Hunter Laboratories. Hunter Laboratories allegedly found it could not compete in a significant segment of the marketplace where major medical laboratories such as Labcorp offered doctors, hospitals and clinics far lower rates than they were charging Medi-Cal. Riedel and Hunter were represented by Niall P. McCarthy of Cotchett, Pitre & McCarthy, LLP, who filed the original whistleblower complaint in 2005 and worked closely with the Attorney's General's Office throughout the entire litigation.
The Attorney General's Bureau of Medi-Cal Fraud and Elder Abuse conducted an intensive three-year investigation that uncovered widespread abuse of Medi-Cal by medical testing laboratories in California, and pursued complaints against several of the labs.
Based on allegations in the complaints, the California Department of Health Care Services, which administers the Medi-Cal program, launched an independent statewide audit of medical laboratories. Through reform of industry pricing practices stemming from this case, Medi-Cal is expected to save hundreds of millions of dollars.
"This settlement reinforces the state's strong commitment to fight fraud against Medi-Cal and all of the state's vital health care programs," said Toby Douglas, director of the Department of Health Care Services. "We will continue to work with our partners at the Department of Justice to ensure that tax dollars invested to serve our state's most vulnerable residents are protected."
Besides providing compensation to the whistleblower under statutory guidelines, the settlement is designed to reimburse the state's Medi-Cal program and the Attorney General for expenses in investigating and prosecuting false claims actions. After payment of the whistleblower share, the government will receive $35,145,000 as a result of this settlement.
The settlement also requires Labcorp to report information to assist the state in determining Labcorp's future compliance with Medi-Cal's pricing rules.
Similar cases are still pending against three other defendants.
Also assisting in the case was the Office of the Inspector General of the U.S. Department of Health and Human Services.
Among those in the Attorney General's office who were instrumental in this case: Aviva Burmas, Doug Cantrell, Sharon Crotteau, Vincent DiCarlo, Dennis Fenwick, J. Timothy Fives, Brian Frankel, Alissa Gire, Jennifer Gregory, David Guon, Sharon Harris, Brian Keats, Eileen Landon, Linda McCrackin, Larry Menard, Kelli O'Neill, Susan Park, Kim Reed, Marcy Rodriguez, James Shannon, Annette Silva, Jill Spitz, Tom Temmerman, Claude Vanderwold, Kenneth Vo, Lawrence Wold, Mark Zahner, and Gary Zerbey.
A copy of the complaint, which has been redacted by court order at Labcorp's request to remove allegedly confidential business information, can be found here: http://ag.ca.gov/cms_attachments/press/pdfs/n2556_complaint1.pdf. The settlement agreement can be found here: http://ag.ca.gov/cms_attachments/press/pdfs/n2556_settlement1.pdf.
To report fraud or abuse, call the Bureau of Medi-Cal Fraud and Elder Abuse hotline at (800) 722-0432.
You are literally insane if you think Labcorp and Quest willfully over billed for these tests. This is old news, and given the amount they bill state and federal plans, there will be more mistakes.
The bottom line is, since the early 1990s Labscam era, the large labs are the most OIG monitored most compliant. These labs have massive fiduciary responsibility to their shareholders and any purposeful or reckless practices can send these multi-billion-dollar market caps in a death spiral. Use some common sense … Bro.
The bottom line is, since the early 1990s Labscam era, the large labs are the most OIG monitored most compliant. These labs have massive fiduciary responsibility to their shareholders and any purposeful or reckless practices can send these multi-billion-dollar market caps in a death spiral. Use some common sense … Bro.
I will take some time to go state by state and post the settlements here.
People can draw their own conclusions.
If you think being publicly traded makes any difference and that the legal and executive teams don't work together to determine risk vs. reward when it comes to compliance you are just plain wrong.
Just wrong.