The United States Attorney for the Middle District of Florida announced on April 15, 2020 that a Florida pain clinic and associated other defendants have agreed to pay a total of $41 million to resolve alleged violations of the False Claims Act for billing Medicare, Medicaid, TRICARE, and other federal health care programs for medically unnecessary Urine Drug Testing (“UDT”).
The federal government alleged that the defendants knowingly submitted or caused the submission of false claims to federal health care programs for presumptive and definitive UDT, in circumstances where such testing was not medically reasonable or necessary. Presumptive UDT are tests that screen for the presence of drugs, and definitive UDT are tests that identify the amounts of those drugs in a patient’s system.
The federal government alleged that the defendants developed and implemented a policy and practice of automatically ordering both presumptive and definitive UDT for all patients at every visit, without any physician making an individualized determination that either test was medically necessary for the particular patients for whom the tests were ordered. According to the federal government’s allegations, the medically unreasonable and unnecessary definitive UDT was performed at Logan Labs, the medically unreasonable and unnecessary presumptive UDT was performed at Tampa Pain, and the respective resulting false claims were submitted by both Tampa Pain and Logan Labs to federal health care programs, from January 1, 2010 through December 31, 2017.
Contemporaneous with the False Claims Act settlement, Logan Labs entered into an “Integrity Agreement” and Tampa Pain entered into a “Corporate Integrity Agreement” with the Department of Health and Human Services, Office of Inspector General. Both Logan Labs and Tampa Pain are subsidiaries of Surgery Partners Inc.; defendant Doyle is the former CEO of Surgery Partners and Logan Labs, and; defendant Toepke is the former Group President for Ancillary Services at Surgery Partners, with oversight of Logan Labs, and a former Vice President at Tampa Pain.
The allegations that are the subject to the settlement were originally alleged in two cases filed under the whistleblower, or qui tam, provision of the False Claims Act. The Act permits private parties to sue for fraud on behalf of the United States and to share in any recovery. The Act also permits the United States to intervene in such actions, as the United States previously did in the two whistleblower cases. The whistleblowers in this case will receive approximately $7.79 million of the settlement.
The two lawsuits are captioned United States ex rel. Ashton v. Logan Laboratories, LLC, et al., Case No. 16-4583 (E.D. Pa.) and United States ex rel. Cho v. Surgery Partners Inc., et al., Case No. 8:17-cv-983 (M.D. Fla.).
If you have information regarding false claims having been submitted to Medicare, Medicaid, TRICARE, other federal health care programs, or to other federal agencies/programs, and the information is not publically known and no actions have been taken by the government with regard to recovering the false claims, you should promptly consult with a False Claims Act attorney (also known as qui tam attorneys) in your U.S. state who may investigate the basis of your False Claims Act allegations and who may also assist you in bringing a qui tam lawsuit on behalf of the United States, if appropriate, for which you may be entitled to receive a portion of the recovery received by the U.S. government.
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