Nevada Medical Practice Agrees to Pay $1 Million to Resolve Allegations of False Medicare Reimbursement Claims
Medical practice billed Medicare for expensive urine drug testing it did not use
BOSTON – Nevada Advanced Pain Specialists (NAPS), a Reno-based medical practice, has agreed to resolve allegations that it submitted false claims for payment to Medicare for medically unnecessary urine drug testing (UDT).
Pursuant to the settlement agreement, NAPS admits that it ordered confirmatory UDT—testing designed to confirm the results of presumptive UDT—despite failing to first obtain presumptive UDT results. In fact, NAPS did not consult the presumptive UDT results before ordering their confirmation but continued to perform presumptive tests in-house and bill Medicare as if they were medically necessary. NAPS admits that its performance of presumptive UDT played no role in its medical decision-making regarding whether to order confirmatory UDT from a clinical laboratory.
“NAPS ordered presumptive testing in order to collect more from Medicare, not because the tests were medically necessary,” said Acting U.S. Attorney Nathaniel R. Mendell. “It’s not supposed to work that way, of course. NAPS was improperly draining resources from an important federal program, and we commend it for resolving the matter expeditiously.”
“Healthcare providers are expected to closely follow Medicare rules and bill properly — nothing more, nothing less,” said Special Agent in Charge Phillip M. Coyne of the U.S. Department of Health and Human Services, Office of Inspector General. “When that obligation is violated, government health care programs – and American taxpayers – pay the price. We are committed to pursuing these types of allegations along with our law enforcement partners as we work to protect the integrity of our federal healthcare system.”
“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,” said Joseph R. Bonavolonta, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division.
This settlement resolves claims brought as part of a lawsuit filed by a whistleblower under the qui tam provisions of the False Claims Act, which allows private parties to bring suit on behalf of the government and to share in any recovery. In connection with today’s announced settlement, the relator will receive $150,000 of the recovery.
Acting U.S. Attorney Mendell, HHS-OIG SAC Coyne, and FBI Boston SAC Bonavolonta made the announcement today. The Department of Veterans Affairs also provided assistance. Assistant U.S. Attorneys Abraham R. George and Charles B. Weinograd of Mendell’s Affirmative Civil Enforcement Unit handled the matter.