Scorecard: OIG Enforcement Actions against Labs in 2019

Labs remain at the top of the OIG’s enforcement hit list, as illustrated by the number of cases involving labs cited in the agency’s new Semiannual Report to Congress for FY 2019:

• False Billing of CGx Tests: OIG participated in Operation Double Helix, the multidistrict federal/state takedown targeting genetic testing labs, telemed companies and doctors involved in a massive $2.1 billion consumer CGx testing scam;
• Medically Unnecessary Tests: Boston Heart Diagnostics paid nearly $1.729 million to settle claims of encouraging physicians to order 26 kinds of medically unnecessary lab tests that were subsequently billed to Medicare, Medicaid and TRICARE;
• Travel Allowances: OIG auditors concluded that Wisconsin Physician Service paid $353.7K in phlebotomy travel allowances for lab tests with miscalculated prorated mileage, incorrect lab fee schedule rates and/or without necessary documentation supporting payment;
• Reference Testing: CRC Health and its parent Acadia paid $17 million to settle charges of billing West Virginia Medicaid for moderate- to high-complexity tests performed by reference labs as if they were performed by CRC outpatient drug treatment centers, even though those centers didn’t have proper CLIA certification to perform those tests;
• SVT Billing: The largest in a series of settlements for improperly billing Specimen Validity Testing, which unlike the associated urine drug test it’s performed for, is not covered by Medicare, was the $1.346 million paid by Ethos Laboratory in Kentucky; and
• Processing Fee Kickbacks: The $102.2K paid by Midland Medical, Inc. of Florida, one of several labs that settled claims of accepting kickbacks in the form of blood specimen “process and handling” from HDL and Singulex.