Lab Billing Company Settles False Claims Act Allegations Relating to Unnecessary Respiratory Panels Run on Seniors Receiving COVID-19 Tests

FOR IMMEDIATE RELEASE
Friday, June 16, 2023
Lab Billing Company Settles False Claims Act Allegations Relating to Unnecessary Respiratory Panels Run on Seniors Receiving COVID-19 Tests

VitalAxis Inc., a Maryland-based billing company for diagnostic laboratories, has agreed to pay $300,479.58 to resolve False Claims Act allegations that it caused the submission of false claims to Medicare for medically unnecessary respiratory pathogen panels run on seniors who received COVID-19 tests.

Throughout 2020, VitalAxis performed billing services for a diagnostic laboratory in Atlanta, Georgia that provided COVID-19 testing to residents of senior living communities. For one chain of communities, the laboratory directed VitalAxis to bill Medicare for respiratory pathogen panels purportedly ordered by a physician who had not actually ordered the tests and who was ineligible to treat Medicare beneficiaries. VitalAxis found the credentials of a different physician and, without authorization, billed Medicare using that physician’s name. Medicare subsequently paid the laboratory for these medically unnecessary tests.

“Federal health care programs only pay for items or services that are reasonable and medically necessary,” said Principal Deputy Assistant Attorney General Brian M. Boynton, head of the Justice Department’s Civil Division. “Today’s settlement demonstrates our commitment to pursue those who exploited the COVID-19 pandemic by billing the government for wasteful tests that nobody wanted or needed.”

“Unscrupulous companies that exploit the Medicare billing system divert important resources away from the program and abuse patient trust,” said U.S. Attorney Ryan K. Buchanan for the Northern District of Georgia. “This civil resolution confirms that our district is committed to protecting our federal programs from fraud and holding those accountable who knowingly waste taxpayer dollars.”

“When companies bill for medically unnecessary services, they waste valuable taxpayer dollars and undermine the integrity of federal health care programs,” said Special Agent in Charge Tamala Miles with the Department of Health and Human Services, Office of Inspector General (HHS-OIG). “As this settlement illustrates, HHS-OIG is committed to protecting the interests of the American taxpayer and holding health care providers accountable should they attempt to exploit the Medicare program.”

VitalAxis received a credit in connection with the settlement announced today in recognition of their cooperation, including by performing and disclosing the results of an internal investigation, disclosing relevant facts and material not known to the government but relevant to its investigation, providing information relevant to potential misconduct by other individuals and entities, and admitting liability.

The resolution obtained in this matter was the result of a coordinated effort between the Civil Division’s Commercial Litigation Branch, Fraud Section, and the U.S. Attorney’s Office for the Northern District of Georgia, with assistance from the Department of Health and Human Services, Office of the Inspector General.

This matter was handled by Deputy Director Paul R. Perkins of the Civil Division, Commercial Litigation Branch, Fraud Section, and Assistant U.S. Attorney Mellori Lumpkin-Dawson and Civil Investigator Alena Evans of the U.S. Attorney’s Office for the Northern District of Georgia.

The investigation and resolution of this matter illustrates the government’s emphasis on combating health care fraud. One of the most powerful tools in this effort is the False Claims Act. Tips and complaints from all sources about potential fraud, waste, abuse, and mismanagement, can be reported to the Department of Health and Human Services at 800-HHS-TIPS (800-447-8477).

On May 17, 2021, the Attorney General established the COVID-19 Fraud Enforcement Task Force to marshal the resources of the Justice Department in partnership with agencies across government to enhance efforts to combat and prevent pandemic-related fraud. The task force bolsters efforts to investigate and prosecute the most culpable domestic and international actors committing civil and criminal fraud and assists agencies tasked with administering relief programs to prevent fraud by, among other methods, augmenting and incorporating existing coordination mechanisms, identifying resources and techniques to uncover fraudulent actors and their schemes, and sharing and harnessing information and insights gained from prior enforcement efforts. For more information on the department’s response to the pandemic, please visit www.justice.gov/coronavirus.

Tips and complaints from all sources about potential fraud affecting COVID-19 government relief programs can be reported by visiting the webpage of the Civil Division’s Fraud Section, which can be found here. Anyone with information about allegations of attempted fraud involving COVID-19 can also report it by calling the Department of Justice’s National Center for Disaster Fraud (NCDF) Hotline at 866-720-5721 or via the NCDF Web Complaint Form at: www.justice.gov/disaster-fraud/ncdf-disaster-complaint-form.

The claims resolved by the settlement are allegations only, and there has been no determination of liability.

Attachment(s): Download Settlement AgreementTopic(s): False Claims ActComponent(s): Civil DivisionUSAO – Georgia, NorthernPress Release Number: 23-675

Updated June 16, 2023 Original Article