Self-Disclosing Saves Kentucky Lab Over $1 Million in False Claims Settlement
Case: A Kentucky-based lab that made heroic efforts to step up its COVID-19 testing early in the pandemic has agreed to shell $1.25 million for falsely billing Medicare, Medicaid, TRICARE and CHAMPVA for urine drug tests between 2016 and 2018. The U.S. Attorney claimed that Bluewater Toxicology: Submitted claims for definitive urine drug tests of 22 or more drug classes even though it tested for a lower number of classes to secure higher reimbursement; Submitted certain claims without sufficient documentation showing the treating physician’s intent to order the test; and Billed for specimen validity testing (SVT), a procedure to verify that a urine sample for drug testing hasn’t been diluted which isn’t covered by Medicare and other federal health programs. Significance: Even though $1.25 million is a lot of money, the settlement price tag could have been twice as high had the lab not come forward to self-disclose and thereby secure a 1.5 monetary loss rate rather than the triple damages provided for by the False Claims Act.
- Submitted claims for definitive urine drug tests of 22 or more drug classes even though it tested for a lower number of classes to secure higher reimbursement;
- Submitted certain claims without sufficient documentation showing the treating physician’s intent to order the test; and
- Billed for specimen validity testing (SVT), a procedure to verify that a urine sample for drug testing hasn’t been diluted which isn’t covered by Medicare and other federal health programs.
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