A Tampa Bay pain center, a reference laboratory, and two former executives have agreed to pay the Federal government $41 million to dismiss claims of violations of the False Claims Act (“Lincoln’s Law”) by billing Medicare, TRICARE, and other government health care programs for unnecessary urine tests.
According to investigators, the pain center prescribed urine drug tests (UDT) to its patients in situations when the tests were not medically necessary. They say the clinic developed a policy of ordering such tests for every visit despite no showing that the attending doctor had any medical reason for calling for such tests.
The allegedly unnecessary testing began in 2010 and continued through the end of 2017, with the samples gleaned from such testing forwarded to a local reference laboratory for processing. Both the pain clinic and the reference laboratory subsequently submitted billing paperwork to Medicare, TRICARE, and other federal insurers, allege investigators.
In addition to paying the Federal government $41 million, the defendants have agreed to enter into an agreement with the Department of Health and Human Services, Office of Inspector General to monitor and audit the firm’s billing practices for a period of years.
The allegations against the defendants are the result of the qui tam, or “whistleblower” provision in the False Claims Act. The provision allows whistleblowers to bring suit against those they suspect of fraud, with the Federal government taking over prosecution of the case if it deems the case to be worthwhile.