Medically unnecessary urine drug testing (UDT) remains a primary target for federal fraud enforcers and whistleblowers. North Carolina-based Radeas LLC is the most recent lab to fall into the dragnet, agreeing to shell out $11.6 million to settle charges of falsely billing Medicare for such tests.
Between January 2016 and September 2021, Radeas billed Medicare for two types of UDT:
- Relatively inexpensive presumptive tests for qualitative detection of drugs; and
- High-cost tests that quantitatively confirm the results of presumptive tests and identify the types of drugs used.
Medicare covers confirmatory tests, provided that they’re medically necessary. Specifically, a physician must order the confirmatory test for the particular patient after reviewing the results of the presumptive test. The problem is that Radeas allegedly performed both tests at about the same time and then submitted the results to the physician. It then billed Medicare for the confirmatory tests even though there was no documentation to support that they were medically necessary.
In addition to the $11.6 million payment, the settlement requires Radeas to enter into a five-year corporate integrity agreement under which it will have to undergo regular review and annual compliance audits from the U.S. Department of Health and Human Services’ Office of Inspector General.