Labs In Court: A roundup of recent cases and enforcement actions involving the diagnostics industry

Spine Clinic Owner Indicted for Falsely Billing Quantitative Urinalysis Tests

Case: The co-owner and billing manager of a Louisiana spine and pain management clinic have been charged with falsely billing Medicare and private insurers for $4.4 million worth of medically unnecessary services, including $3.9 million in quantitative urinalysis tests. The clinic was planning to open a urinary testing lab and began storing specimens for unnecessary testing once the lab went on line, the indictment claims.

Significance: The Louisiana spine clinic principals are among the over 400 defendants charged with health care fraud as part of the 2017 National Health Care Fraud Takedown spanning 41 federal enforcement districts and 30 State Medicaid Fraud Control Units.

Genetic Testing Company Linked to Indiana False Billing Prosecution

Case: Now we know why the FBI raided the HQ of Proove Biosciences in Southern California. The genetic testing company is apparently caught up in a Takedown case targeting illegal dispensing of oxycodone and opioids by Physicians Primary Care (PPC) in Indiana. The indictment claims that 3 individuals affiliated with PPC, including an MD and 2 nurse practitioners, caused Proove to fraudulently bill for genetic tests administered to PPC patients that were medically unnecessary and never interpreted.

Significance: It's important to note that Proove hasn't been formally charged with any offenses. And in a recent statement, the company's founder and CEO emphasized 3 key points, including the fact that Proove:

• Received written and signed medical necessity determinations for the tests in question;

• Cut ties with the indicted PPC physician immediately upon learning of the investigation in 2014; and

• Has cooperated with the FBI and U.S. Attorney's office.

Five More Doctors Convicted in BLS Bribery Scheme

Case: The biggest medical bribery scandal of all time continues to grow with 5 more doctors pleading guilty to taking bribes from now defunct Biodiagnostic Laboratory Services LLC (BLS) in Parsippany, New Jersey. Here's the Scorecard for the latest defendants:

Significance: In a sneak preview of what the future may hold for these five when sentence is handed down in December, the very same day the above convictions were announced, a 79-year-old Bergen County (NJ) family physician was sentenced to 41 months in prison for taking $200,000 in bribes for approximately $3 million's worth of illegal lab business to BLS. The latest BLS "body count" is 50 convictions, 36 of them doctors.