A Connecticut Medical Assistance Program (CMAP) licensed laboratory will be fined $656,912 and excluded from Connecticut’s Medicaid program for 10 years after allegations surfaced that it knowingly marketed an unnecessary drug testing package.
The state of Connecticut alleges that Precision Testing Laboratories, Inc. (PTL), a Southbridge, Massachusetts laboratory, “aggressively” marketed an expensive and unnecessarily complex drug testing package to residential drug treatment facilities and sober homes, a Feb. 16 press release by Attorney General George Jepsen’s office said.
“PTL knew that the facilities and homes did not provide a physician-managed drug treatment program and the need for drug testing at those facilities and homes was limited to ensuring sobriety as a condition of residency and, therefore, a less expensive drug test result would have sufficed,” the press release said.
PTL promoted itself as a laboratory that was committed to providing urine drug testing services to those in recovery from substance abuse, the press release said.
“The state…alleged that PTL submitted false claims to the CMAP for expensive drug tests that were not medically necessary as required under PTL’s provider agreement,” the press release said. “(They) were not part of a physician’s drug treatment program, not specifically tailored to address each individual resident’s particular medical condition and much more costly than alternative less costly drug testing.”
Jepsen said in the press release that enforcement of the False Claims Act, which imposes liability on persons and companies who defraud government programs, continues to be a priority of his office.
“Medical necessity is an important distinction in Medicaid provider agreements, and we alleged that this provider knew that it was violating its provider agreement in billing Medicaid for these expensive tests, yet did so regardless.” Jepsen said. “This provider diverted taxpayer funded monies intended to help address drug and alcohol abuse treatment into his own pocket,”
Jepsen said his office and its law enforcement partners are committed to protecting the public and are “vigorously pursuing” all those who knowingly submit false claims that affect the state’s Medicaid program.
Connecticut Department of Social Services (DSS) Commissioner Roderick Bremby said in the press release that though outliers like PTL don’t represent Medicaid providers as a whole, the Attorney General’s enforcement action “clearly underscores the fact that strong anti-fraud measures are needed to protect the integrity of public health coverage programs.”
“As administering agency for Medicaid, DSS thanks and commends Attorney General Jepsen and his staff, the Massachusetts Attorney General’s Office, our own investigators and other state and federal partners for outstanding work in rooting out fraud and abuse,” Bremby said.
The $656,912 settlement agreement is comprised of $394,147 that represents the state’s share of the funds, which will be returned to the CMAP program, according to the press release. The remaining funds will be remitted to federal Medicaid.
Both PTL and its president and owner, David Fromm, have agreed to and executed an agreement with DSS that excludes them from participating in CMAP for 10 years, the press release said.
“Today’s action is part of a larger effort by the State of Connecticut’s Interagency Fraud Task Force, which was created in July 2013 to wage a coordinated and proactive effort to investigate and prosecute healthcare fraud directed at state healthcare and human service programs,” the press release said.
Anyone with knowledge of suspected fraud or abuse in the public healthcare system is asked to contact the Attorney General’s Antitrust and Government Program Fraud Department at (860) 808-5040 or by email at email@example.com.
Gabriella DeBenedictis is a staff writer for The Daily Campus. She can be reached via email at firstname.lastname@example.org.