Lawsuit is a strong reminder that clinical laboratories and pathology groups must take whatever steps necessary to secure their patients’ protected health information
Lehigh Valley Health Network (LVHN), one of the largest primary care groups in Pennsylvania, will pay out $65 million to settle a class-action lawsuit brought by the healthcare network’s own patients (identified only as “Jane Doe” in court documents) following a ransomware attack early last year in which LVHN refused to pay the ransom.
The payout may be the largest settlement for a single cyberattack to date and highlights the need for clinical laboratories and pathology groups to review their cyberattack defenses and incorporate steps to better secure patient protected health information (PHI), with one goal being to minimize the possibility of patients filing a class action lawsuit following a cyberattack.
LVHN blamed ransomware group ALPHV (a.k.a., BlackCat) for the attack, Fierce Healthcare reported. The hackers gained access to gigabytes of personal data belonging to 134,000 patients and staff members.
According to a news release LVHN issued in June, the private information the thieves obtained included, “names, addresses, phone numbers, medical record numbers, treatment and diagnosis information, including Current Procedural Terminology (CPT) codes, and health insurance information. For some individuals, the information included email addresses, banking information, Social Security numbers, and driver’s license numbers. The information for a limited number of individuals included clinical images of patients during treatment.”
The case is worth attention because it casts light on what the health system administration did/did not do to prevent the data breach that enabled the hackers to post nude photos of cancer patients undergoing treatment and other patient PHI on the Internet.
“When you go to the doctor’s office, that’s one place where you’re anticipating that everyone is working to maintain your privacy, even though you have to open yourself up to be treated,” said Patrick Howard, JD (above), partner at Philadelphia-based Saltz Mongeluzzi Bendesky P.C., who is representing the plaintiffs in the class action lawsuit. “It wasn’t lost on anyone that that was a very significant breach.” Clinical laboratories are particularly vulnerable since as much as 80% of a patient’s health record is lab test results and other data. (Photo copyright: Saltz Mongeluzzi Bendesky P.C.)
Lawsuit Details
The class action lawsuit was filed in March 2023 by a “Jane Doe” cancer patient whose data was hacked on behalf of herself and other victims of the cyberattack. The court documents recount how the unidentified plaintiff—a woman in her 50s—was “called by the hospital’s vice president of compliance on March 6, with news that that naked images of her were now online, before offering—‘with a chuckle’—two years of credit monitoring services. The Jane Doe plaintiff responded that she had no idea that the hospital had taken photographs of her while unclothed during her treatment for breast cancer, nor that it was storing them on corporate servers.”
“The pictures are really difficult to look at,” said Patrick Howard, JD, partner at Philadelphia-based Saltz Mongeluzzi Bendesky P.C. (SMB), who is representing the plaintiffs, in a news release. His legal team hired a cybersecurity expert who located the images the hackers had posted on the Dark Web, enabling them to “establish each person’s information that was actually online.”
The plaintiff’s attorney’s argued LVHN failed in its responsibility to protect patient information and were in violation of HIPAA (Health Insurance Portability and Accountability Act of 1996).
The class action lawsuit also alleges LVHN routinely took photos of naked cancer patients, sometimes without their knowledge. Some of those photos were published by BlackCat on the Dark Web.
“While LVHN is publicly patting itself on the back for standing up to these hackers and refusing to meet their ransom demands, they are consciously and intentionally ignoring the real victims,” the lawsuit states. “Rather than act in their patients’ best interest, LVHN put its own financial considerations first.”
The law firm also stated this settlement is “the largest of its kind, on a per-patient basis, in a healthcare data breach ransomware case,” The Register reported.
Patients affected by the security breach were placed in relief tiers based on the private information that was stolen and leaked. The compensatory breakdown for those patients is:
$50 to patients whose records were hacked.
$1,000 to patients who had their information posted online.
$7,500 to patients whose non-nude photos were posted online.
$70,000 to $80,000 for patients who had their nude photos posted online.
“We struck the right deal,” Howard told WHYY News. “The vast majority of that money is going to mostly women whose images were published online, in topless fashion, with both their face exposed and their name in the files.”
Game Changing Data Breach
LVHN originally announced an attack had been detected in February 2023. On March 4, 2023, the ALPHV hackers demanded a ransom in excess of $5 million from LVHN, threatening to distribute the stolen data unless the ransom was paid. LVHN refused to pay the ransom which led to the cybercriminals uploading the stolen data to the Dark Web.
“Attacks like this are reprehensible and we are dedicating appropriate resources to respond to this incident,” stated Brian Nester, DO, President and CEO, LVHN, in a news release.
“The type of data that was exposed, it’s a game changer,” said Carter Groome, founder and CEO of digital-risk firm First Health Advisory in the SMB news release. “This was so much more of a tangible, direct distress to those people who trusted the organization.”
“Pictures are part of medical care. That’s something that they do to track scarring and all sorts of things. But they are the most delicate and sensitive medical information,” Howard told WHYY News. “I think this case will be talked about in healthcare circles for some time in best practices in storing those types of images.”
Patients had until October 21, 2024, to exclude themselves from or object to the settlement. The deadline to submit a claim form was November 3, 2024, and the final approval hearing was held on November 15, 2024.
LVHN agreed to the terms of the settlement, whilst denying any wrongdoing on its part. Individuals in the settlement class who chose to participate in the lawsuit will be sent payment automatically.
LVHN has established a website for people seeking information about the cyberattack.
As ransomware attacks continue to increase, clinical laboratories and pathology groups should review their cyberattack defenses and determine how to better secure their patients’ protected health information. Taking necessary precautions could minimize the possibility of patient data being compromised and prevent another huge class-action lawsuit.
Strikes could lead to delays or cancelations of as many as 123,000 clinical laboratory test across the nation’s healthcare system
Once again, New Zealand medical laboratory workers are returning to the picket line. On March 6, APEX, a specialist union representing more than 4,000 allied, scientific, and technical health professionals throughout New Zealand, issued a strike notice to “three corporate laboratory companies—Awanui, Pathlab, and Medlab,” according to an APEX news release.
“Over 850 laboratory scientists and technicians across New Zealand will take rolling strike action over seven days beginning on 22 March, with at least 123,000 patient tests impacted. Over 70% of New Zealand towns and cities including Tauranga, Rotorua, Palmerston North, Gisborne, Wellington and Dunedin will lose access to medical laboratory testing for their public hospital, or primary care system, or both for a minimum of 72 hours,” the news release notes.
“Pathlab staff across Waikato, Bay of Plenty and Taupō will strike from March 24 until March 26, Awanui staff in Wellington and Canterbury will strike from March 25 until March 27, and Medlab workers in the MidCentral region will strike for a full week from March 22 until March 28. Auckland and the West Coast are the only regions where no labs are affected,” The Post reported.
“Those who use and rely on laboratory services need to brace for impact. We estimate that over 123,000 tests normally carried out as part of urgent or routine patient testing will not be performed during the week of strikes,” said Deborah Powell, MBChB, APEX National Secretary, in the news release.
“We are keen to work with the laboratory employers to resolve this dispute,” said Deborah Powell, MBChB (above), APEX National Secretary, in the news release. “Patients, clinicians, and laboratory workers are now stuck between the rock of underfunding and the hard place of corporate ownership of the medical laboratory sector. To avoid these rolling strikes, we need all parties to the dispute to work together to come up with a creative and sensible solution which works for everyone.” Clinical laboratories in the US may want to pay close attention to the struggles of their counterparts in New Zealand. (Photo copyright: New Zealand Doctor.)
Private Lab Ownership versus Public Funding
In February, more than 900 New Zealand medical laboratory workers nationwide walked off the job to protest “poor conditions and a lack of pay parity with the public sector,” according to the Otago Daily Times. Until now, that was the latest labor action in the ongoing struggle.
But those walkouts did not produce the results the union organizers had hoped.
“We didn’t get what we wanted at all,” Pathlab Tauranga senior medical laboratory scientist Steven Clements told NZ Herald. “We feel like there’s a lot of blame being passed between our employer and the government.”
Clements claimed the New Zealand government made its “standard statement” about it not being involved in private laboratory negotiations.
“They actually provide almost all of our funding, so we feel like the government hasn’t particularly listened. We also feel like our employer maybe isn’t really supporting us … so it’s led to another strike,” he said.
“We are in the weird situation where the employers agree with us,” said APEX National Secretary Powell, NZ Herald reported. “Pay parity between public and corporate employed lab scientists and technicians is the only fair, just, and sustainable solution to this dispute. Unfortunately, the lab triopoly are refusing pay parity without further government funding,” she added.
Disruptions in Care
As is the case with any strike, they are disruptive. During the February strikes, NZ Pathology Chairman, Peter Gootjes, DPH, director of the Awanui Group, told the New Zealand Doctor that they were trying to minimize any disruptions. The New Zealand Association of Pathology Practices (NZ Pathology), according to the organization’s website, is the “collective voice of New Zealand’s private sector laboratory providers, representing the views and aspirations of the funded pathology sector.”
“Our laboratories play an essential role in the provision of healthcare services, and we are working closely with the union, hospitals, and health professionals to ensure essential life-preserving services remain available and ongoing disruption to the community can be minimized,” Gootjes told New Zealand Doctor.
“Pathology sits at the heart of modern healthcare,” he continued. “Ensuring New Zealanders have access to quality, reliable, efficient and trusted pathology services is vital to patient care and public health. These services are a fundamental, yet often unseen, component of the clinical pathway for patients.
“We understand the concerns raised by APEX members and recognize the challenges posed by pay discrepancies following the previous government’s pay equity settlements for public sector employees. We are committed to working constructively with government and officials on this matter,” he said.
Pathlab, Health NZ Respond
In separate statements, Pathlab and Health NZ-Te Whatu Ora (New Zealand’s primary publicly funded healthcare system) attempted to address the APEX lab workers’ demands and assure the public.
“We value [APEX workers’] work and have engaged with APEX in good faith, doing everything we can within the funding we receive. … The problem is that private laboratories, including Pathlab, receive the vast majority of their funding through long-run bulk-funded contracts with Health NZ that pre-date the settlement and are inflexible when it comes to unforeseen cost increases, such as this one,” Pathlab’s chief executive Brian Millen stated, adding, “We remain committed to finding a workable solution while continuing to provide the high-quality services our communities rely on,” NZ Herald reported.
Health NZ, which, according to NZ Herald, “was aware Apex members were in collective bargaining … [but] not involved in this as they did not employ the private sector workforce,” sought to ensure that the strikes’ impact on hospitals and community healthcare services would be minimal.
“All our hospitals and emergency departments will remain open, and we are liaising with the private laboratories to ensure patients who require urgent and critical care receive the services they need, including testing carried out at hospitals and in the community,” said Health NZ, adding, “We respect the right of workers to take strike action and any questions about this matter should be directed to the employers or the union.”
Dark Daily has covered these ongoing strikes in many previous ebriefings. Clinical laboratory and pathology professionals in the United States should take note of their New Zealand counterparts’ recent and ongoing struggle for fair pay and safe working environments. America is no stranger to issues like these and our lab workers could find themselves in a similar situation.
Polling indicates one in eight recruiters refuse to hire ‘unprepared for workforce’ college graduates in 2025
When it comes to hiring entry-level employees, a new national survey of managers in charge of recruiting for their companies offers insights about recently graduated Generation Z (people born between 1997 and 2012) candidates. All clinical laboratories and pathology groups regularly have the opportunity to hire new college graduates. Thus, these valuable findings may help inform clinical laboratory recruitment and retention practices.
Seattle-based Intelligent.com used the market research platform Pollfish to conduct the survey in December 2024 to learn if perceptions of Gen Z workers were true.
“In recent years, a narrative has emerged that Gen Zers aren’t excelling in the workforce due to poor attitudes and work ethic,” said Intelligent.com in a news release.
The company surveyed 1,000 hiring managers on their attitudes about where new college graduates stand in getting hired. The researchers found that one in eight recruiters said they will avoid hiring recent college graduates in 2025. And 55% said they participated in a company decision to terminate a recent college graduate in 2024.
As a Fortune notes, “the class of 2024’s shortcomings will impact future grads.”
An earlier poll conducted by Intelligent.com in September found that three out of four companies surveyed had difficulties with newly hired graduates.
“Among these companies, only 25% state that all recent college graduate hires worked out well, while 62% mention that only some were successful. Further, 14% report that only a few or none of the hires were successful,” Intelligent.com reported.
“Many recent college graduates may struggle with entering the workforce for the first time as it can be a huge contrast from what they are used to throughout their education journey. They are often unprepared for a less structured environment, workplace cultural dynamics, and the expectation of autonomous work,” said Huy Nguyen (above), chief education and career development advisor at Intelligent.com, in a news release. Clinical laboratories and pathology groups may be experiencing similar circumstances with their own Gen Z workers. (Photo copyright: LinkedIn.)
Recent Graduates Lack ‘Work Ethic’
Here are more findings from the Intelligent.com survey of hiring managers. According to the survey:
33% of hiring managers said, “recent graduates lack work ethic.”
24% said new grads are “unprepared for the workforce.”
25% reported recent grads are “unprepared for interviews” and that they “struggle with eye contact, professional appearance, and salary negotiations.”
29% described new grads as “entitled.”
28% said the job candidates “lack motivation.”
27% found new graduates could be “easily offended.”
25% said new grads had trouble with feedback and 23% said they had trouble with punctuality.
20% said new graduates need to be “micromanaged.”
20% of hiring managers said recent grads have “poor communication skills,” while 17% cited “laziness” as a problem with recent graduates.
Nevertheless, companies have entry-level positions to fill in 2025, according to 97% of the hiring managers. Twelve percent of those surveyed told Intelligent.com they planned to “prioritize hiring older candidates” instead of the college grads.
For their part, according to Fortune, colleges “know their students are wholly unprepared for the workforce” and are trying to help them. For example, Michigan State University teaches students conversation-building skills including knowing when “the other party is starting to get bored,” Fortune reported.
Intelligent.com urged hiring managers to step-up interviewing techniques that better reveal a job candidate’s true potential.
“Instead of avoiding recent college grads based on biases and stereotypes, hiring managers need to identify individuals with demonstrated motivation, adaptability, and growth potential. Skills can be taught to those with the right attitude,” said Huy Nguyen, chief education and career development advisor at Intelligent.com, said in a news release.
“Although they may have some theoretical knowledge from college, they often lack the practical, real-world experience and soft skills required to succeed in the work environment. These factors, combined with the expectations of seasoned workers, can create challenges for both recent grads and the companies they work for,” he said.
“It can be easy for managers to buy into typical stereotypes of Gen Z and dismiss them entirely; however, companies have an equal responsibility to prepare recent graduates for their particular workplace and give them the best chance to succeed. By understanding the challenges of Gen Z workers, companies can take a more proactive approach by implementing formal employee onboarding programs that clearly outline company culture and expectations. Paring recent grads with mentors in the company can also pay huge dividends as that can provide Gen Z workers with the guidance, feedback, and support for them to succeed,” he advised.
Recruitment is costly. Clinical laboratory hiring managers can learn from the Intelligent.com survey findings. Those who develop a deeper understanding of Gen Z job candidates’ expectations and capabilities straight out of college stand a better chance of hiring personnel who will establish a positive, long-term working relationships with the lab.
Plan offers members transparent pricing for medications and 24/7 virtual consults
Amazon is working to be price competitive in the healthcare products and services it provides. A recently launched plan offers Prime members fixed prices and affordable monthly rates for telehealth visits, treatment plans, and medication delivery for various types of health, beauty, and lifestyle care. Healthcare providers such as office-based physicians, clinical laboratories, and anatomic pathology groups, may once again be impacted by Amazon’s foray into medical care.
This is not the first time that Amazon (NASDAQ:AMZN) has waded into the medical pond. In 2022, the Seattle-based ecommerce company purchased One Medical (NASDAQ:ONEM) for $3.9B while at the same time launching Amazon Clinic (now known as Amazon One Medical Pay-per-visit), a virtual healthcare service, in an attempt to “reinvent” healthcare. Dark Daily covered these events in an ebrief at that time.
Since then, Amazon has offered pay-per-visit telehealth consultations to determine treatments for more than 30 common ailments such as pink eye (conjunctivitis), flu, and sinus conditions. Now, Amazon is adding “low, clear upfront pricing for a clinical visit, treatment plan, and fast, free medication delivery for Prime members for a range of common health, beauty, and lifestyle concerns, including anti-aging skincare treatment, men’s hair loss, erectile dysfunction, eyelash growth, and motion sickness,” according to an Amazon news release.
“We’re committed to giving customers convenient, affordable care options that put them in control of their health,” said Bergen Penhart, general manager for Amazon One Medical Pay-per-visit, in the news release. “This new offering makes it easy for Prime members to get expert clinical advice and prescribed treatments for common health, beauty, and lifestyle needs, all from the comfort of home.”
The platform supports both on-demand messaging and virtual video telehealth visits to address more than 30 common medical issues.
“This simple care experience was built to meet the needs of today’s customer. At Amazon, we’re working to reduce the burden on patients who’d like to move forward with care, but may be tired of navigating the hurdles of our healthcare system, waiting in a long line at the pharmacy, or worried about a surprise bill or medication cost,” said Harvard-trained lung specialist and chief medical officer for Amazon, Vin Gupta, MD (above). “We’re helping patients re-engage in care and spend time doing what they love instead.” These new medical initiatives from Amazon are meant to be convenient for patients, but have an impact on local healthcare providers, clinical laboratories, and pharmacies. (Photo copyright: Vin Gupta, MD.)
Convenience, Transparency, 24/7 Access to Healthcare
Telemedicine has seen a sharp rise in recent years, aided by necessity during the COVID-19 pandemic. Forbes reports that the percentage of hospitals offering telemedicine rose to 72% in 2021. Since so many Americans today use the Internet for everything from shopping for medications to interfacing with healthcare providers, it makes sense that Amazon, one of the world’s most successful online retailers, would want a cut of the action.
So what is the retail giant offering now that improves upon its previous healthcare services? It is promoting fixed prices and monthly payments with complete transparency. There are also no surprise bills for Amazon One Medical patients. Prime members can see the price for their telehealth consultation and prescription before deciding whether to go forward with the appointment and treatment.
In addition, Amazon One Medical patients can use a smartphone app (available on both Android and Apple iPhone) to review prices for treating five common health conditions and beauty treatments, as well as meeting virtually with a clinician 24/7 from anywhere in the world. In some areas Amazon even offers same-day or next-day medication deliveries.
“This simple, upfront pricing helps customers shop for their healthcare and make informed, confident decisions. Customers only pay for the cost of the consultation and medication (if prescribed). There are no additional fees, expenses, or subscriptions needed beyond Amazon Prime,” the news release states.
First Wrongful Death Lawsuit Filed against Amazon One Medical
However, the road to success in healthcare is not without its potholes. In “Amazon One Medical Call Centers Found Wanting in Washington Post Report,” we covered a 2024 Washington Post story on leaked documents that appeared to indicate Amazon’s One Medical primary care call center was not using trained, certified medical professionals to field patient phone calls and provide telehealth guidance.
This led to disappointment among Amazon One Medical patients, we reported.
According to The Washington Post, Amazon bought One Medical and hired workers for their call centers with “limited training and little to no medical experience.” This allegedly caused serious medical issues such as high blood pressure spikes and blood in stool to go unrecognized.
Caroline O’Donovan, the Washington Post reporter who broke the story, told PBS, “In the documents that were leaked to us, there’s a doctor who wrote a note saying, ‘I don’t think these call center people even realize that they’re triaging patients, which is not something that they’re qualified to do.’”
Amazon acknowledged that initial calls could have been handled more effectively, however the company insisted that no patients were harmed. In an email statement, Amazon spokesperson Dawn Brun said, “We take patients’ feedback seriously and the [Washington Post] story mischaracterizes the dedication we have to our patients and care teams.”
Nevertheless, Amazon One Medical now faces a lawsuit. The Daily Mail reported that Suzanne Tong of Oakland, Calif., is suing Amazon for negligence after her husband died following a video consultation during which he was told to “take an inhaler” for symptoms that included shortness of breath and blue feet.
“Hours later, the 45-year-old was rushed to the emergency department at the Alta Bates Summit Medical Center, where [according to court documents] he ‘collapsed in the waiting room and expired,’” The Daily Mail reported, adding, “The [court] filing claims that ‘to a reasonable degree of medical certainty,’ if Mr. Tong had received the ‘proper care, treatment and follow up’ at his appointment with Amazon One Medical on December 18, 2023, he would have survived.”
Amazon would not comment on the impending litigation citing patient privacy concerns, instead providing a statement to the press. In it, an Amazon One Medical spokesperson said, “While we are prohibited by law from discussing patient records, we refute claims that a change in the duration of visits or location of a virtual visit has impacted the care provided at Amazon One Medical,” the Los Angeles Times reported. “We care deeply about every patient we serve, and the quality and safety of our care are our highest priorities. We’re proud of our extensive quality and safety measures, and of the health outcomes we help our patients achieve. We take concerns about our care extremely seriously, and we’re committed to continuous improvement.”
According to The Daily Mail, this is the first wrongful death lawsuit brought against Amazon One Medical.
Warning to Clinical Labs, Pathology Groups
Stories like these raise questions as to whether the quality of care delivered by various telehealth services is being sacrificed for the sake of convenience and price transparency. Americans are increasingly living more online. Medical services moved online out of necessity, and many healthcare providers who stayed online have expanded their offerings due to customer demand.
Clinical laboratories and anatomic pathologists would be wise to stay informed on this growing trend. These business launches are a warning shot for lab managers and pathology groups to invest time and money becoming more patient/consumer friendly providers with websites that feature price transparency.
Dettwyler is set to retire at age 92 after a long career helping clinical laboratories with their coding and billing systems
When William Dettwyler, MT, began working in a clinical laboratory, Harry Truman was president of the United States and scientists had not yet discovered the structure of DNA. Now, as he approaches his 92nd birthday in March, he is finally ready to retire from a career that has spanned more than seven decades, from bench work as a medical laboratory technician (MLT) to assisting labs with their medical coding and medical billing challenges.
Along the way, one of his coding innovations helped the State of Oregon save substantial sums in its Medicaid program. He also helped many medical laboratories increase reimbursement by correcting their coding mistakes. This from someone who left school after eighth grade to help on his family’s farm in rural Oregon.
In an exclusive interview with Dark Daily, Dettwyler discusses his long career and offered pointers for labs on improving their coding and reimbursement procedures.
Back in the 1980s, when he began his consulting work for labs, “they were very poor at billing,” he recalled. “Hospital billing staff didn’t understand lab coding. Reference laboratories didn’t do a good job of picking the right codes or even billing all the codes. Up until around the 1970s, hospitals didn’t even have to bill individual lab procedures with CPT codes. They billed with a revenue center code for all their lab services.”
These days “people are much more sophisticated,” he notes. “There are fewer coding problems compared to what it was in the 1980s and 1990s up to the 2010s.” However, he says he still has a handful of clients who call on his expertise.
“It was not unusual to go to a large university medical center and in three days tell the CFO on my exit review that the following year their lab would bring in about a half million more in revenue, just from my coding review. But I did not reveal to them that I had only gone to the eighth grade in a little one room school and was the lone graduate in my eighth-grade class,” wrote William Dettwyler, MT (above), owner of Codus Medicus in Salem, Ore., in an article he penned for Medical Laboratory Observer. For 75 years Dettwyler worked in the clinical laboratory industry. For much of that time he helped labs all over America improve their coding and reimbursement systems. (Photo copyright: LinkedIn.)
How It All Began
Dettwyler got his first taste of lab work in the early 1950s as a teenager washing glassware for a medical laboratory technician at a local medical practice. A few years later he completed an MLT program at Oregon Institute of Technology in Klamath Falls and landed his first lab tech job at a clinic in Portland.
His entry to consulting came in the early 1970s while he was working for a medical group in Salem. “I was helping the accounting personnel with their billing and noticed that Medicaid was not paying for a common test for syphilis that I was performing,” he recalled. “I contacted Medicaid, and they told me they didn’t understand laboratory procedures.”
After that, “they started to call me frequently with laboratory questions,” he said. “It wasn’t long before they asked me to help them on a part-time basis.” He also assisted with questions related to radiology.
By 1976, Dettwyler was devoting 35 hours a week to assisting the state Medicaid agency while still working as a lab tech.
Simple Hack Ends Overpayments
One of his career highlights came around 1981, when he discovered that the agency was overpaying for some pathology and radiology procedures by as much as 200%.
“Pathologists and radiologists are paid based on whether they are performing the complete procedure—the technical component and the professional component—or just the professional component, where they interpret the results,” he explained.
When billing for just the professional component, the physicians would add two digits to the standard code, so it might come in as 88305-26. However, the state’s computer system could only accommodate a five-digit code, so the state was paying as if the providers had done everything.
“The computer techs said the software couldn’t handle a seven-digit number in a five-digit box, so I devised a way for the computer to read the equivalent of seven digits,” he recalled.
His solution was to modify the codes so that the last digit was an alphabetic character. Instead of billing for code 88305-26, the physicians would bill for 8830F, and the state would pay them correctly.
Around that time, Dettwyler also began assisting a Medicare office in Portland. This forced him to cut back on his work as a lab tech. But he still worked around 60 hours a week.
“For most of my life, I’ve worked three jobs,” he said. “Work is my hobby.” He also had a large family to support—by 1976, he and his wife had 10 kids.
Transition to Lab Consulting
In 1986, the state was facing a budget shortfall and cut its Medicaid consultants, so Dettwyler decided to seek consulting work with labs while continuing to work at the bench.
“I really liked the coding because I had very little competition,” he said. “But I wanted to keep working in the laboratory mainly to understand the problems.”
While working for the state, Dettwyler attended coding seminars and workshops. He noticed that labs were losing revenue due to poor billing practices. “They didn’t understand all the coding complexities, so they really hungered for this kind of assistance.”
But first, he had to find clients. So he partnered with another lab tech who was offering similar consulting services.
Business picked up after Dettwyler contributed an article to the trade publication Medical Laboratory Observer about his process, which he calls “procedure code verification and post payment analysis.”
“That went like gangbusters,” he said. “We started getting calls from all over the country.”
Dettwyler later split from his partner and went to work on his own.
“I would sit down with the person who was responsible for coding, usually the lab or radiology manager,” he explained. “We would go over the chargemaster and cover every procedure to make sure the code and units were correct. When I was done, I would give them a report of what codes we changed and why we changed them.”
Beginning in 1989, he signed on as a contractor for another consultancy, Health Systems Concepts on the East Coast, where he remained until 2019.
Advice to the Current Generation
What is Dettwyler’s advice for someone who wants to follow in his footsteps and assist labs with their coding? “I wouldn’t recommend it now,” he said. “There’s less need for that kind of assistance than in the past.”
However, he does find that labs still run into problems. The greatest need, he says, is in molecular diagnostics, due to the complexity of the procedures.
In addition, labs are sometimes confused by coding for therapeutic drug monitoring, in which a doctor is gauging a patient’s reaction to a therapy versus screening for substance abuse. “Those issues are often misunderstood,” he said.
Microbiology also poses coding challenges, he noted, because of the steps required to identify the pathogen and determine antibiotic susceptibility. “It requires quite a bit of additional coding,” he said. “Some labs don’t understand that they can’t just bill a code for culture and sensitivity. They have to bill for the individual portions.”
Labs that work with reference labs also have to be careful to verify codes for specific procedures. “I’ll review the codes used by reference labs and, surprisingly, they’re not always correct. Reference labs sometimes get it wrong.”
If someone does want to become a coding expert, Dettwyler suggests that “they should first have experience as a lab tech, especially in microbiology, because of the additional coding. And they should try to work with somebody who is already doing it. Then, they should work with the billing department to learn how it operates.”
He also advises clinical laboratory managers to follow the latest developments in the field by reading lab publications such as The Dark Report. “You have to do that to keep current,” he said.
Despite never completing high school, Dettwyler eventually received his GED and an associate degree. “But the degrees didn’t really help me,” he said. “Much of it was on-the-job training and keeping my eyes open and listening.”
Endemic in the Amazon region, recent spread of the disease caused the CDC to issue recommendations to travelers who develop symptoms after visiting certain countries
Anatomic pathologists, microbiologists, and clinical laboratories active in infectious disease testing will want to stay informed about the worldwide progression of the Oropouche virus. The infectious pathogen is spreading beyond the Amazon region (where it is endemic) into more populated areas—including the US—and possibly being transmitted in novel ways … including through sexual activity.
The virus primarily spreads to people through biting small flies called midges (a.k.a., no-see-ums), according to a CDC Health Alert Network (HAN) Health Advisory, which added that mosquitoes can also spread the disease.
Oropouche infections, the CDC said, are occurring in Brazil, Bolivia, Peru, Columbia, and Cuba. Cases identified in the US and Europe seem to be among travelers returning from those countries. Reported cases also include deaths in Brazil and cases of mother-to-child (vertical) transmission.
There is “an increase in Oropouche virus disease in the Americas region, originating from endemic areas in the Amazon basin and new areas in South America and the Caribbean,” CDC noted in its Health Advisory.
Though de Oliveira notes that a global outbreak is not yet expected, researchers are nevertheless raising the alarm.
“The challenge is that this is such a new disease that most clinicians—including infectious disease specialists—are not aware of it and we need to make more patients and healthcare providers aware of the disease and increase access to diagnostics so we can test for it,” said David Hamer, MD (above), infectious disease specialist and professor, global health, at Boston University School of Public Health, in an NPR article. “Over the next year, we are going to learn a lot more.” Pathologist, microbiologists, and clinical laboratories will want to keep an eye on the spread of the Oropouche virus. (Photo copyright: Boston University.)
Risks to Pregnant Women, Seniors
Research published in The Lancet Infectious Diseases estimates up to five million people in the Americas are at risk of exposure to the Oropouche virus. The authors also pointed out that cases in Brazil swelled from 261 between the years 2015 to 2022 to 7,497 by August 2024.
About 60% of people infected with Oropouche have symptoms such as fever, chills, headache, muscle aches, and joint pains, according to the CDC Health Advisory, which added that the symptoms generally appear three to 10 days after exposure.
Those with the highest risk of complications from the disease, according to the CDC, include pregnant women, those over age 65, and people with medical conditions such as:
“The geographic range expansion, in conjunction with the identification of vertical transmission and reports of deaths, has raised concerns about the broader threat this virus represents in the Americas,” an additional paper in Emerging Infectious Diseases noted.
“Healthcare providers should be aware of the risk of vertical transmission and possible adverse impacts on the fetus including fetal death or congenital abnormalities,” CDC said in an Oropouche Clinical Overview statement.
“There have been a few cases of maternal to fetal transmission, and there are four cases of congenital Oropouche infections that have been described—all of which led to microcephaly, which is a small head size,” David Hamer, MD, infectious disease specialist and professor global health, Boston University School of Public Health, told NPR.
Diagnostic Testing at Public Labs
Clinical laboratories and physicians should coordinate with state or local health departments for Oropouche virus testing and reporting.
People should consider Oropouche virus testing if they have traveled to an area with documented or suspected cases, have symptoms including fever and headache, and have tested negative for other diseases, especially dengue, according to CDC.
Taking Precautions after Sex
“This [possibility of sexual transmission] brought up more questions than answers,” Hamer told NPR, adding, “we know now is that sexual transmission could happen.”
Though no documented cases of sexual transmission have been recorded, the CDC nevertheless published updated interim guidance, “recommending that male travelers who develop Oropouche symptoms after visiting areas with Level 1 or 2 Travel Health notices for Oropouche to ‘consider using condoms or not having sex for at least 6 weeks’ from the start of their symptoms,” NPR reported.
“Because stillbirths, birth defects, and severe complications and deaths in adults have been reported, CDC is providing interim recommendations on preventing possible sexual transmission based on what we know now,” the CDC stated.
Clinical laboratory leaders working with infectious disease colleagues can help educate physicians and the community about the Oropouche virus and the need to prevent bites from midges and mosquitoes by using, for example, Environmental Protection Agency (EPA) registered insect repellant.
Diagnostics professionals will want to stay abreast of developing Oropouche cases as well as changes to or expansion of clinical laboratory testing and reported guidance.
