The Department of Justice has recovered $1 million in a urine drug testing fraud settlement with Nevada Advanced Pain Specialists (NAPS). The False Claims Act (FCA) settlement resolves allegations that the Reno-based medical practice submitted false claims to Medicare. The government alleges that NAPS conducted urine drug testing (UDT) that was not medically necessary. Moreover, NAPS then submitted those false claims for reimbursement to Medicare, resulting in false claims.
The Alleged Urine Drug Testing Fraud
The government’s allegations involve improper billing for urine drug tests. There are two types of urine drug tests at issue. First, there is a drug screening test, known as a presumptive UDT. Second, there is a more precise test that can identify the concentration of a drug in a patient’s urine. This second type of test is known as a confirmatory UDT.
The government alleges that NAPS ordered the second-level confirmatory test without first getting the results of the initial presumptive test. That is, NAPS would conduct a presumptive urine drug test in-house. But rather than waiting for the result before proceeding to the confirmatory test, NAPS would always order the second-level confirmatory test. In fact, NAPS admits that it did not even review the result of the first test before ordering the confirmatory urine drug test.
Yet NAPS still billed Medicare for the presumptive urine drug test as if it were medically necessary. Moreover, NAPS admits that the result of the presumptive test played no role in its medical decision-making.
NAPS ordered urine drug tests to collect money from Medicare – not because the tests were medically necessary. This scheme violated the FCA. In addition, it drained resources from an important federal program. Joseph R. Bonavolonta, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division explained:
Public health insurance programs, such as Medicare, incur staggering financial losses when their programs are exploited. Today’s settlement should make it perfectly clear that those who bill for medically unnecessary tests will be held accountable.
This is One of Several Recent Urine Drug Testing Fraud Settlements
A whistleblower brought this fraud to light. The whistleblower filed a lawsuit under the qui tam provisions of the False Claims Act. The Act allows a private party, called a “relator,” to bring a suit on behalf of the government and to share in the government’s recovery. The relator received $150,000 of the government’s $1 million recovery. This whistleblower suit fits right in with several other recent FCA actions involving urine drug testing.
Rhode Island
Just last year, the United States Attorney’s Office for the District of Rhode Island filed suit against several related medical groups and their owner. The government alleges that the medical groups collected $1.5 million from Medicare and Medicaid for urine drug tests they did not perform.
Connecticut
In June, Connecticut Addiction Medicine (“CAM”) paid $1 million in a urine drug testing fraud settlement. The government alleged that the practice billed Medicare and Medicaid for medically unnecessary urine drug tests. For each patient, CAM used presumptive UDT and ordered confirmatory UDT. Because of this tactic, Medicare and Medicaid overpaid CAM for unnecessary UDT. As a result, these critical programs had less money for legitimate medical needs.
Our Ongoing Urine Drug Testing Fraud Case
Last year, the Massachusetts Attorney General intervened in one of our client’s cases. As we describe in more detail here, the defendant (CleanSlate Centers) operated a chain of for-profit addiction-treatment centers. These centers exploited the national opioid epidemic with a model that prioritized profit over patient care. As part of the scheme, CleanSlate required unnecessary and expensive urine drug testing at every patient visit.
As Massachusetts Attorney General Maura Healey explained:
This company’s business model was to illegally profit by cheating our state Medicaid program, which provides vital health care resources to some of our most vulnerable residents. We will take legal action against this kind of misconduct in order to recover funds for our state and protect the integrity of MassHealth.
Whistleblowers with information about these schemes can play a role in stopping fraud and protecting taxpayer dollars. If you have information about urine drug testing fraud, or any other health care fraud scheme, we can help. Please contact us for a free, confidential conversation.
