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Laboratory and IDTF

This archive displays posts tagged as relevant to laboratories and independent diagnostic testing facilities. You may also be interested in our pages:

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November 1, 2022

Electronic health record technology vendor Modernizing Medicine, Inc. (“ModMed”) has agreed to pay $45 million to resolve allegations, including by its former VP of Product Management, that it both received and provided illegal kickbacks in exchange for referrals.  According to the government and whistleblower Amanda Long, ModMed engaged in schemes with Miraca Life Sciences, Inc. (now known as Inform Diagnostics) to receive kickbacks in exchange for recommending its users for Miraca’s lab services, and to provide its EHR technology free to healthcare providers to entice them to direct lab orders to Miraca and add to ModMed’s user base.  Long will receive about $9 million of the settlement with ModMed.  USAO NJ

October 17, 2022

Sutter Health has agreed to pay more than $13 million to settle claims of billing Medicare, Medicaid, TRICARE, and the Federal Employees Health Benefits Program for quantitative urine testing that were in fact performed by third-party labs.  The company has already paid more than $6.5 million and is due to pay the remaining $6.5 million in the next 30 days.  USAO NDCA

October 3, 2022

Medical sales representative Steven Monaco has been sentenced to 14 years in prison for orchestrating two fraud schemes that led to multimillion dollar losses to federal, state, and private health insurance plans.  In the first scheme, Monaco arranged for a doctor’s medical assistant to be placed on the payroll of a medical diagnostic laboratory in exchange for all of the doctor’s labwork.  In the second scheme, Monaco arranged for doctors to sign medically unnecessary prescriptions for expensive compounded medications, on behalf of patients they never evaluated, in exchange for illegal kickbacks.  Monaco received $36,000 from the first scheme and $350,000 from the second scheme, and caused over $4.6 million in losses to the insurance plans.  USAO NJ

October 3, 2022

South Carolina-based Radeas, LLC has agreed to pay $3.6 million to settle allegations of submitting false claims to North Carolina’s Medicaid program.  Radeas had allegedly billed Medicaid for simultaneously-performed presumptive and definitive urine drug tests, in violation of Medicaid policy and standard practice to run definitive tests after presumptive tests come back positive.  NC AG

August 23, 2022

Texas-based Cockerell Dermatopathology (CDP) has agreed to pay $3.75 million to resolve allegations of allowing millions of dollars in fraudulent claims to be submitted to TRICARE, in violation of the False Claims Act.  According to a government suit, CDP’s principal physician, Dr. Clay Cockerell, had allowed laboratory management company Progen to use its license to submit false claims for medically unnecessary tests in exchange for a twenty percent cut of the proceeds.  USAO NDTX

July 27, 2022

ca Glenn Pair and Markuetric Stringfellow will spend 70 and 78 months in prison, respectively, and pay over $5 million each in restitution for defrauding three States’ Medicaid programs of more than $5 million, and for receiving $1.8 million in kickbacks from participating laboratories. The two owned and operated Do-It-4-The Hood Corporation in North Carolina and later expanded to Georgia. They targeted Medicare-eligible children, enrolled them in their programs, and required them to submit urine specimens for drug testing. Drug testing was in turn billed to Medicaid by complicit laboratories, who then paid kickbacks after receiving Medicaid reimbursement. Through their Wrights Care Services LLC franchise in South Carolina, the two filed fraudulent Medicaid claims for mental health counseling, going so far as to host a “note party,” upon learning of a Medicare audit of Wrights Care, to cover up their scheme by creating false billing records to substantiate their fraudulent Medicaid claims. USAO WDNC, USAO SC

July 22, 2022

Metric Lab Services, LLC, Metric Management Services LLC, Spectrum Diagnostic Labs LLC, and two of their owners, Sherman Kennerson and Jeffrey Madison, will pay $5.7 million to resolve allegations of False Claims Act violations. In their genetic testing fraud scheme, Metric and Spectrum paid kickbacks to certain marketers who solicited generic testing samples from Medicare beneficiaries, with false physician attestations that the testing was medically necessary. Kennerson and Madison both pled guilty to one count of conspiracy to defraud the U.S. and are currently awaiting sentencing. DOJ, NJ USAO

July 20, 2022

Texas-based clinical laboratory Inform Diagnostics, Inc., formerly known as Miraca Life Sciences, Inc., has agreed to pay $16 million to resolve allegations of violating the False Claims Act.  Inform admitted that it had a policy of conducting additional tests on biopsy specimens without an individualized determination on whether additional tests were medically necessary, then submitting bills for those unauthorized and unnecessary tests to Medicare and other federal healthcare programs.  USAO MA

July 14, 2022

BioReference Health, LLC, formerly known as BioReference Laboratories, Inc. and OPKO Health, Inc., have agreed to pay nearly $10 million and enter into a five-year Corporate Integrity Agreement to settle a whistleblower-brought case alleging it violated the Anti-Kickback Statute, Stark Law, and False Claims Act.  The alleged misconduct involved making lease payments to healthcare providers that exceeded fair market value, and later failing to report or return any overpayments to federal healthcare programs.  USAO MA

June 28, 2022

Fifteen additional doctors affiliated with a kickback scheme involving Rockdale Hospital d/b/a Little River Healthcare, True Health Diagnostics LLC, and/or Boston Heart Diagnostics Corporation, have agreed to pay a cumulative $2.8 million to settle allegations of violating the Anti-Kickback Statute and Stark Law by accepting improper remuneration in exchange for ordering tests from those laboratories.  According to the press release, the government has now recovered over $32 million from settlements with thirty-three doctors, two executives, and one laboratory in connection with this scheme.  USAO EDTX
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