Medical Testing Fraud Draws Increasing Scrutiny from DOJ in Recent Whistleblower Cases
Over the previous months, the United States has intervened in multiple whistleblower cases involving unnecessary medical testing conducted by clinical laboratories and health care providers in several states. These cases demonstrate not only the increased scrutiny with which the DOJ has approached medical testing fraud under the False Claims Act (FCA) but also the vital role of whistleblowers in uncovering and addressing this fraud.
Recent Cases Involving Medical Testing Fraud
In April 2022, the DOJ reported that Physician Partners of America (PPOA) agreed to pay $24.5 million to settle allegations that they violated the False Claims Act. After several former PPOA employees filed qui tam complaints against the company, the DOJ intervened in the action.
According to the settlement agreement, the DOJ claimed that PPOA billed Medicare for urine drug testing (UDT) in violation of the Stark Law, which prohibits physician self-referrals. By systematically requiring physicians to order UDT that was neither reasonable nor medically necessary, PPOA, according to the DOJ, defrauded the United States of millions of dollars over a span of six years. The DOJ further alleged that PPOA had repeatedly submitted false claims to Medicare and TRICARE for other drug tests, genetic tests, and psychological tests that were neither reasonable nor medically necessary. In addition, the DOJ claimed that, from the beginning of the COVID-19 pandemic, PPOA scheduled frequent, unnecessary evaluation and management appointments with patients and billed federal healthcare programs for these visits.
As another example, just last week, the DOJ amended its complaint in another ongoing whistleblower case involving multiple hospitals and medical laboratories across Texas, New York, and Pennsylvania to include several more physician defendants.
In its complaint, the DOJ alleges that Boston Heart Diagnostics Corporation (BHD) and True Health Diagnostics LLC (THD), two clinical laboratory companies, conspired with multiple health care providers and physicians in Texas to pay the providers kickbacks for laboratory tests ordered from BHD and THD. In many instances, the complaint alleges, doctors ordered tests that were neither reasonable nor necessary, yet these tests were improperly billed to Medicare, Medicaid, and TRICARE. Though this case is still ongoing, the United States has previously recovered over $30 million related to alleged FCA violations by THD and BHD.
The Role of Whistleblowers in Uncovering Medical Testing Fraud
As both of the preceding cases demonstrate, whistleblowers have played a paramount role in uncovering illegal kickback schemes and the fraudulent billing of unnecessary medical tests to federal healthcare programs. Though fraud remains prevalent and widespread in the healthcare industry, many instances of fraud would never come to light without the valuable information provided by whistleblowers.
Under the FCA’s qui tam provisions, individuals with inside knowledge of healthcare fraud or kickback schemes like those discussed above are encouraged to bring allegations of fraud. Successful whistleblowers not only receive up to 30% of the recovered sum but also are protected by the FCA’s anti-retaliation provisions.
At Price Armstrong, our attorneys have extensive experience litigating fraud under the False Claims Act. If you have information about potential fraud against the government, you may have a valuable claim as a whistleblower. Contact us today for a free initial consultation and review of your case.