JACKSONVILLE, Fla. – A physicians group, Coastal Spine and Pain, has agreed to pay $7.4 million to the federal government to resolve allegations that it violated the False Claims Act by performing medically unnecessary drug screen procedures, the U.S. Department of Justice said Wednesday.
The settlement relates to the business' use of tests that identify and count particles of illicit drugs in patients' urine. The DOJ said the quantitative drug tests, which are very specific and expensive, are appropriate only if there is reason to doubt the more general and cheaper qualitative drug test screens. However, the DOJ said regardless of results of the less expensive test, Coastal performed and billed all patients for the quantitative drug tests.
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The government reported the quantitative tests were medically unnecessary and there was no reason to question further the results of the qualitative urine screenings.
“The U.S. Attorney’s Office is committed to taking the steps necessary to protect Medicare, TRICARE and other federal health care programs from fraud,” U.S. Attorney A. Lee Bentley said. “When health care practitioners conduct medical tests, they must only bill for them when it is appropriate and medically necessary.
"We will vigorously pursue providers that perform tests indiscriminately, regardless of need.”
The DOJ said in every instance Coastal billed for a qualitative drug test screen, it also billed for a quantitative drug test screen, which prompted questioning and investigation.
“New and expanded uses of data analytics to identify suspicious billing patterns, such as in this case, are providing law enforcement agencies with powerful investigative tools to combat fraud and abuse in federal health care programs,” HHS OIG SAC Shimon Richmond said. “Medicare should only be paying for medical tests to improve the health of beneficiaries, not the profit margins of unscrupulous physicians.
"Today’s settlement should serve as notice to others that fraud will be vigorously pursued.”
Physicians Group Services released the following statement to News4Jax Thursday:
“Physicians Group Services, P.A., doing business as Coastal Spine and Pain Center (“Coastal”) resolved an investigation brought by the federal government. Coastal denies any liability. Coastal was prepared to defend the appropriateness and medical necessity of the quantitative drug testing of our patients. Management decided to settle the matter to avoid expensive and protracted litigation and to allow us to focus on our patients.”