News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

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News, Analysis, Trends, Management Innovations for
Clinical Laboratories and Pathology Groups

Hosted by Robert Michel
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EKRA Now Used to Combat Fraudulent COVID-19 Testing, Too

The Department of Justice steps beyond the law’s original focus on opioid-related lab testing fraud

An interesting aspect with enforcement of the Eliminating Kickbacks in Recovery Act of 2018 (EKRA) is the government’s willingness to go after charges tied to fraudulent COVID-19 testing. 

The case U.S. vs. Malena Badon Lepetich provides a good example of this approach. A grand jury indicted Lepetich on various healthcare fraud charges last year, including that she allegedly offered to pay kickbacks for referrals of specimens for COVID-19 testing.

“The government had really only used EKRA in the context of addiction treatment space,” attorney Alexander Porter, a Partner at law firm Davis Wright Tremaine in Los Angeles, said in the latest issue of The Dark Report. “The Lepetich case shows that the government’s going to use EKRA beyond that context and go into other areas where they think that it can be useful—in particular, in the area of COVID-19 testing.” 

Clinical laboratories and pathology groups should take note of this development.

Attorney Alexander Porter said EKRA enforcement now goes after fraudulent COVID-19 testing. (Photo: Davis Wright Tremaine)

Defendant Allegedly Filed $10 Million in Fraudulent Lab Claims

Lepetich was the owner of MedLogic, a clinical laboratory in Baton Rouge, La.

In addition to the fraudulent COVID-19 testing charges, she allegedly solicited and received kickbacks in exchange for referrals of urine specimens for medically unnecessary tests, according to the U.S. Department of Justice (DOJ). 

The DOJ said Lepetich filed more than $10 million in laboratory test claims to Medicare, Medicaid, and Blue Cross Blue Shield of Louisiana for panels of expensive respiratory tests that were medically unnecessary. 

EKRA Provisions Rose from the Opioid Crisis in the U.S.

EKRA is a criminal law that falls under the Communities and Patients Act, which lifted restrictions on medications for opioid treatment and sought to limit overprescribing of opioid painkillers. Originally, EKRA targeted fraudulent practices at sober homes and substance abuse treatment centers. However, the final draft of the bill added clinical laboratories to the list of providers under potential scrutiny.

At the time Congress passed EKRA, the law was primarily aimed at fraudulent activity in opioid treatment centers, including related lab testing.

Thus, the government’s use of EKRA in the COVID-19 charges against Lepetich case is newsworthy and establishes a precedent, noted Porter. He’ll speak about EKRA at the 2022 Executive War College on Laboratory and Pathology Management. The event takes place April 27-28 in New Orleans.

A contentious part of EKRA for clinical laboratories and pathology groups is that certain conduct protected under the federal Anti-Kickback Statute is treated as a criminal offense under EKRA. Some common lab practices come under that confusing designation, such as paying lab sales reps on a commission-based formula based on testing volumes they generate. 

—Scott Wallask

Related Information:

Labs Should Be Cautious About “Surprising” EKRA Ruling

DOJ Announces Coordinated Law Enforcement Action to Combat Healthcare Fraud Related to COVID-19

Executive War College on Laboratory and Pathology Management

6 Impacts of EKRA on Laboratories, Clinics, and Other Treatment Facilities

Revenue Recovery and Collections Solutions for Your Laboratory

Who We Are: You deserve to get paid. Since 1970, TSI has been helping healthcare providers of all sizes with their revenue cycle management. With more than 35,000 clients and $900M recovered in 2016 alone, we have the size, scale and industry knowledge you can count on, plus we can weather the consolidation storm. All types of medical laboratories, medical facilities and physician groups are among the 20,000+ current healthcare clients.

We pride ourselves on our engagement of consumers, which includes using a sympathetic and diplomatic approach in our communications to help maintain the relationships your facility worked so hard to create.

Our Services: Transworld Systems effectively collects on past due statements while ensuring that patients feel comfortable returning for medical care after responding due to our diplomatic third-party intervention.

Our first party, third party, and late stage collections services provide the right solution at the right time, while our industry-leading focus on data analytics, compliance, and cyber security ensure your patients, your data, and your brand are protected.

TSI’s Profit Recovery solution provides our exclusive and proven collection demand letters and/or calls series to get you paid while maintaining diplomatic relations with your patients. With this fixed fee service, payments go directly to you and you keep 100% of the recovered funds. With TSI Profit Recovery, you’ll reduce operating costs by freeing up staff time and recover more. Our Commitment To You: TSI is committed to maintaining the highest standards of cyber security. Our combination of technology and human resources enables us to safeguard the data entrusted to us by both clients and consumers. We’ve obtained all necessary cyber security compliance certifications to ensure all client and consumer sensitive data remains secure, including being PCI compliant, FISMA compliant, as well as undergoing an annual SOC 1 security audit and regularly-scheduled third-party risk assessments. Note:

  • Compliance organization of 60+ people with specialization
  • Reports directly to Board
  • CEO and Compliance Head are ex Federal Regulators
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Accolades: Transworld Systems recently attained the prestigious Peer Reviewed by HFMA (Healthcare Financial Management Association) status. Products or services that carry the HFMA Peer Review status have passed a rigorous third-party evaluation process.

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  Your TSI Representative: Michael Paro

Michael Paro

With over two decades of sales and consulting experience, Michael Paro has developed a keen sense for problem resolution, policy and procedure development, organizational management and performance analysis. Mike has advised Fortune 2500 companies nationwide. Likewise for small businesses, real estate investors, health-care practices and facilities. All were engaged in services which resulted in an immediate impact to the bottom line and a realization of increased shareholder value.

For More information please contact Mike directly at:


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Leading National Provider of Laboratory Billing and Revenue Cycle Management to Healthcare Service Providers


Founded in 1981, Physicians Group Management (PGM) is a leading national provider of laboratory billing and revenue cycle management to healthcare service providers. We have a range of products and services that provide our clients with a complete platform encompassing the entire laboratory workflow. Through a commitment to service excellence and customer satisfaction, PGM has become one of the fastest growing laboratory medical billing companies in the United States.

Comprehensive Laboratory Billing Services

With a rich history of working with laboratories on a national basis for over than three decades, PGM has developed one of the most effective laboratory billing, coding and financial management services on the market today. When labs partner with PGM, they can more effectively manage high-volume claims; improve collection rates; reduce administrative, human resources, staffing and technology expenses; and gain revenue cycle management insight through in-depth financial management reports.

Through every step of the billing and coding process, the PGM team of certified laboratory billing and coding specialists will work closely with your team to ensure we develop a billing and coding strategy that is truly customized to meet your strategic business needs and objectives. Our full-service laboratory billing handles all aspects of billing.

The following are some of the PGM services available for your laboratory:

  • Customized Laboratory Information System (LIS) Integration
  • Accession or patient encounter monitoring to ensure every case is submitted for reimbursement
  • Monitoring of payments to ensure adherence to contracted rates
  • Statements for patient balances
  • Handling of patient inquiries regarding billing questions
  • Guidance on pricing
  • Accurate financial reporting, billing, coding and collections
  • Cost-effectively processing high-volume claims to increase revenue
  • Implementation of best practices to reduce days in A/R
  • Minimizing of write-offs and bad debt by actively working and following up on denied claims
  • Controlling costs by measuring and tracking productivity and profitability by procedure, by site of service, by physician and by salesperson
  • Personalized assistance through dedicated account representatives

Extensive Medical Billing Experience and Solutions

In addition to serving all types of laboratories, PGM’s client base encompasses the full spectrum of medical specialties, including internal medicine, dermatology, plastic and reconstructive surgery, pathology, EMS and ambulatory services, cardiology, nephrology, urology, pain management, OB/GYN and gastroenterology. Our robust platform of solutions includes:

We’re Ready to Help Your Lab Increase Revenue and Reduce Costs

To learn more about PGM’s laboratory medical billing and coding services, contact us for more information.