Mount Washington Laboratory Agrees to Pay $ 1.2 Million to Resolve False Claims for Urinary Drug Testing Services | USAO-EDKY

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LEXINGTON, Ky. Bluewater Toxicology, LLC, a clinical laboratory in Mount Washington, Ky., Has agreed to pay $ 1,252,403.40 to resolve civil claims that it violated the False Claims Act, a federal law that prohibits submit false or fraudulent claims to the federal government. .

Under the settlement agreement, the United States has alleged three issues with Bluewater’s requests for urine drug testing services that Bluewater has made to Medicare, Kentucky Medicaid, Indiana Medicaid, TRICARE and CHAMPVA. First, the United States claimed that Bluewater made claims that distorted the number of classes of drugs tested. Specifically, the United States argued that from January 2016 to September 2018, Bluewater submitted requests for definitive urine drug tests for 22 or more drug classes. The United States has alleged that these claims are false because Bluewater has tested fewer than 22 classes of drugs. By charging as if they were testing for a greater number of courses, Bluewater ensured the higher refunds it was not entitled to.

Second, the United States has alleged that from January 2016 to December 2017, Bluewater made certain claims without sufficient documentation to support the intention of the attending physicians to order the billed test. By billing for these tests, Bluewater again ensured reimbursements to which it was not entitled.

Finally, the United States alleged that Bluewater billed Medicare for sample validity testing, a quality control process used to analyze a urine sample to ensure that it had not been diluted. or falsified. As of January 2014, Medicares guidelines indicate that sample validity tests should not be billed separately to Medicare. The United States has alleged that Bluewater nonetheless submitted claims to Medicare for sample validity testing during the period October 2014 to May 2016.

Whenever the valuable resources of government health care programs are dissipated to those who are not entitled to them, it diminishes the ability of these critically important programs to meet the needs of their beneficiaries, said Carlton S Shier, IV, Acting Attorney for United States. for the Eastern District of Kentucky. We must all remain committed to doing our part to protect the tax security of these vital resources.

This case stems from Bluewaters’ self-disclosure of false claims regarding urine drug testing services. Because Bluewater self-disclosed the misconduct, she was only able to settle her liability for 1.5 times the amount of monetary loss caused by her misrepresentation. By law, the False Claims Act imposes liability for three times the amount of losses suffered by the government.

Healthcare providers may voluntarily disclose self-discovered fraud evidence to the Office of the Inspector General of the US Department of Health and Human Services. More information on how to self-disclose misconduct under the Supplier Self-Disclosure Protocol is available at https://oig.hhs.gov/compliance/self-disclosure-info/protocol .asp.

The United States also encourages anyone with information about potential fraud, abuse, or mismanagement of Medicare or Medicaid funds to call the U.S. Department of Health and Human Services hotline at 800-HHS-TIPS (800- 447-8477). False Claims Act allegations can also be made under the qui tam provisions of the law, which encourage whistleblowers to sue on behalf of the United States and potentially participate in any financial recovery.

This investigation was conducted by the United States Attorneys Office for the Eastern District of Kentucky, the Kentucky Attorney General’s Office for Medicaid Fraud and Abuse Control, the Medicaid Fraud Control Unit of Attorney General of Indiana, the US Department of Health and Human Services Office of the Inspector General, the Division of Program Integrity of Defense Health Agencies and the Office of the Inspector General of the Department of Veterans. The United States was represented by Deputy United States Attorney Meghan Stubblebine.

The settlement resolves claims claimed by the United States; there was no determination of responsibility.

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