Electronic Health Records Vendor NextGen Healthcare, Inc. To Pay $31 Million To Settle False Claims Act Allegations
The United States Attorney’s Office for the District of Vermont announced today that Dominion Diagnostics, Inc. has paid $815,000 in total to the United States and the State of Vermont to resolve civil claims that Dominion Diagnostics violated the federal False Claims Act, 31 U.S.C. § 3729, and the Vermont False Claims Act, 32 V.S.A. § 630, by knowingly presenting, or causing to be presented, false claims for payment to Medicare and Medicaid. The money will be divided between the federal Medicare, federal Medicaid, and Vermont Medicaid programs to which Dominion Diagnostics submitted the alleged false claims.
Dominion Diagnostics provides clinical drug monitoring solutions, clinical information, and support services to a variety of medical specialties. This includes urine drug testing and routine clinical blood testing to support screening, diagnosis and monitoring. Dominion Diagnostics is based in North Kingston, Rhode Island and has an office and does business in Vermont.
The United States and the State of Vermont contend that from January 1, 2010 through December 23, 2015, Dominion Diagnostics knowingly presented or caused to be presented claims for payment from Medicare and the Vermont Medicaid program for urine specimen validity testing when referring physicians did not specifically order specimen validity testing. The United States and the State of Vermont contend Dominion Diagnostics’ standing orders automatically included these validity tests without consideration as to whether the referring physicians had actually ordered the validity tests. In addition, the State of Vermont contends Dominion Diagnostics adopted and put into effect a new Usual & Customary Rate for certain claims and impermissibly gave that rate retroactive application on claims submitted to the Vermont Medicaid program.
“As exemplified by this settlement, health care companies doing business in Vermont who take shortcuts or ignore programmatic requirements, such as individualized medical necessity determinations, will face serious consequences,” said United States Attorney Christina E. Nolan. “We will pursue and hold accountable those who knowingly or recklessly bill the government for health care services without proper authorization and justification.”
The settlement announced today resolves the foregoing allegations without the need for litigation. Pursuant to the terms of the settlement agreement, the agreement and payment are neither an admission of liability by Dominion Diagnostics, nor a concession by the United States or State of Vermont that their claims are not well founded.
This matter was investigated by the United States Attorney’s Office for the District of Vermont, with assistance from the Office of the Inspector General of the Department of Health and Human Services, and by the Medicaid Fraud and Residential Abuse Unit of the Vermont Attorney General’s Office. Assistant United States Attorney Nikolas P. Kerest handled the matter on behalf of the United States. Vermont Assistant Attorney General Steven J. Monde of the Medicaid Fraud and Residential Abuse Unit represented the State of Vermont. R. Jeffrey Behm of the law firm Sheehey, Furlong & Behm, P.C., represented Dominion Diagnostics.