Physicians Toxicology Laboratory, LLC (PTL), a Tampa-based medical lab, has reached a $4.4 million settlement agreement with the United States Attorney for the Western District of Michigan to resolve allegations that it violated the False Claims Act (FCA).
Mark Totten, the U.S. Attorney for the Western District of Michigan, announced the settlement, claiming that PTL had pushed doctors to order unnecessary urine drug and hormone level tests, which were then submitted to Medicare for reimbursement.
This was all alleged to be part of a scheme to artificially increase profits at the expense of taxpayers who fund the Medicare Benefits Program.
“Lab tests should be ordered based on each patient’s medical needs and not just to increase laboratory profits,” said U.S. Attorney Mark Totten. “Laboratories and ordering practitioners must comply with the rules. We will not tolerate conduct by Medicare-enrolled practitioners and laboratories that raises Medicare costs and wastes taxpayer funds.”
The government claimed that PTL collaborated with medical practices throughout Michigan, encouraging them to order urine drug tests (UDTs) for Medicare patients even when the tests were not medically required. These tests were then routinely billed to Medicare for approximately three years.
The tests in question consisted of both presumptive and definitive UDTs. A presumptive UDT is a simple test to determine the presence or absence of illegal substances, whereas the latter is more advanced and typically more expensive, yielding detailed results on detected drug types and total concentration levels.
Medicare has stringent guidelines that require tests to be ordered based on individual patient needs. Blanket orders for UDTs are not accepted. However, according to the government, PTL encouraged doctors to issue blanket orders for all Medicare patients without considering whether they were truly necessary.
PTL allegedly employed urine collectors at some medical offices, who completed these blanket orders for the practices before submitting them to the lab for billing to Medicare.
The lab did not stop there. PTL also allegedly billed Medicare for additional hormone tests included with standard UDT orders, despite the fact that these tests were typically already covered by the standard reimbursement costs associated with UDT claims.
One Michigan medical practice is said to have ordered these hormone tests along with almost every UDT and submitted claims for them.
Previously, the government settled similar claims with two Michigan medical practices for a total of $188,633.18. These practices included Grand Rapids’ Family Health Partners and Ionia’s Advanced Pain Solutions, both of which had submitted fraudulent claims for unnecessary tests.
As part of the settlement, PTL, its parent company Lund Capital Group, former PTL President Matthew Ryan Lund, and Thomas C. Lund signed a three-year Integrity Agreement with the Department of Health and Human Services Office of Inspector General (HHS-OIG).
This agreement requires PTL to establish a compliance program, appoint a clinical director to oversee policies governing medical decision-making, and hire an independent organization to review claims for medical necessity.
“Health care providers are expected to follow the rules and regulations of the Medicare program, but knowingly submitting claims for medically unnecessary services violates that trust and wastes valuable taxpayer dollars,” said Special Agent in Charge Mario M.
Pinto of the United States Department of Health and Human Services Office of Inspector General. “This settlement reflects the commitment of HHS-OIG and the U.S. Attorney’s Office to protect the integrity of the Medicare program by working together to hold providers that submit false claims accountable for their actions.”
While PTL’s settlement agreement does not admit guilt or liability, the case raises serious concerns about honesty and integrity in the healthcare system, particularly regarding the trust that people place in the Medicare Program for their care.
This settlement serves as a stark reminder of the ongoing efforts required to protect the Medicare Program from fraud, abuse, and the draining of funds necessary for those who may rely on the program for medical bill assistance in the future.
