Co-Owner of Kentucky Lab Pleads Guilty to Reference Lab Conspiracy

Case: This story is about a medical billing firm T. Monroe Medical Billing and its toxicology lab client Compliance Advantage LLC (CAL) that were partially owned by the same gentleman. The problems began in 2016 when Medicaid, Aetna and Humana accused the lab of improper billings and cut payments to the facility. Aetna also demanded that CAL repay $750K. To get around the ban and generate revenue, the co-owners cut a reference lab agreement with a third lab (not named in the court papers) enabling Monroe and CAL to bill the payors for tests that were actually performed by CAL in the name of the third lab. The cut: 60/40 with the third lab taking the 40%. The reference lab agreement was backdated to further the deception. Significance: One of the co-owners pled guilty to one count of conspiracy and now faces up to five years’ in prison when he’s sentenced in June. The other co-owner who had a partial ownership interest in both CAL and Monroe will answer to a higher authority, having died in 2017.