Fraudulent billing by clinical laboratories has been a major concern for government payors such as Medicare, Medicaid, and TRICARE since the early 1990's.
Types of Laboratory Services Fraud include:
- Double billing
- “Unbundling” lab services
- Billing for medically unnecessary lab tests
- Billing for tests not performed
- Billing for tests which were not ordered
These fraudulent practices, and others, may constitute the basis for a whistleblower lawsuit under the False Claims Act.
Real World Examples of Recent Laboratory Services Fraud False Claims Act Cases:
- 2011: Quest Diagnostic paid just over $310 million to the State of California to resolve a whistleblower case alleging that from 1995 to 2011, Quest had billed the California Medicaid program (Medi-Cal) at a higher rate than it billed other payors for the same services in the same conditions. Allegations included the payment of kickbacks to induce providers to refer Medi-Cal patients to its labs for services. The whistleblower received a payment of over $69 million for pursuing the fraud.
- 2012: NextCare Inc., an Urgent Care provider, paid $10 million to resolve allegations that the company submitted false claims to federal and state health care programs by fraudulently billing for medically unnecessary allergy tests, H1N1 virus tests, and respiratory panel tests. The initial whistleblower, represented by Rabon Frazier LLP, shared in an award of over $1.6 million as a result of the settlement.