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Gamma Healthcare Inc. Gamma, a laboratory located in Poplar Bluff, Missouri, and its three ownersJerry W. Murphy, Jerrod W. Murphy, and Joel W. Murphy the Murphyshave agreed to settle allegations of illegally billing Medicare for unnecessary lab tests worth $13.6 million.
This agreement resolves clms that from January 1, 2020, through October 31, 2020, Gamma Healthcare along with the Murphys submitted or caused submissions to Medicare of bills related to laboratory tests which were neither ordered by healthcare professionals nor medically required.
The settlement is based on allegations of billing Medicare for unnecessary polymerase chn reaction PCR urinalysis tests that weren't requested by the patients' treating physicians. The lab would automatically perform and bill Medicare for these tests, known as urinary tract infection UTI panels using PCR when a physician ordered just a regular urine analysis with culture and sensitivity or merely a culture and sensitivity test. On average, Medicare pd approximately $11 for an analysis including culture and sensitivity but clmed about $573 more for the UTI PCR Tests.
The settlement included allegations that by not allowing physicians to opt out of these unnecessary tests, Gamma Healthcare violated federal healthcare programs regulations. Even though healthcare providers expressed concerns as early as March 2020 regarding these tests, Gamma continued to bill Medicare for them, causing a significant financial loss to the program.
Principal Deputy Assistant Attorney General Brian M. Boynton from the Justice Department’s Civil Division emphasized that laboratories are allowed to seek reimbursement only from federal healthcare programs if they perform medically necessary tests ordered by physicians. He went on to say the department will remn vigilant in enforcing these regulations and holds accountable those who misuse or exploit them.
U.S. Attorney Sayler A. Fleming for the Eastern District of Missouri expressed gratitude towards whistleblower Bradley Bibb M.D., highlighting his role in bringing this issue forward. As a result of Dr. Bibb's effort, Gamma Healthcare Inc., along with its owners are now barred from participating in federal health care programs for 15 years and will pay $13.6 million to Medicare.
The government’s emphasis on tackling healthcare fraud is highlighted through the False Clms Act, which enables individuals including whistleblowers to report potential violations of law concerning the mismanagement or illegal activities in the healthcare sector.
The False Clms Act allegations are only clms, not a verdict of guilt, and no liability has been determined up until this point. The resolution demonstrates how the government uses its authority under the False Clms Act to protect federal healthcare funds from misuse.
Settlement Highlights
Gamma Healthcare Inc., an established laboratory in Poplar Bluff, Missouri.
Allegations agnst Jerry W. Murphy, Jerrod W. Murphy, and Joel W. Murphythe company's ownersof fraudulent billing practices.
$13.6 million settlement agreement between Gamma Healthcare and the government to address clms of unnecessary lab test billing.
The False Clms Act empowers whistleblowers like Dr. Bradley Bibb to report potential healthcare fraud concerns. This case showcases how such reports can lead to significant settlements and restrictions on individuals or entities accused of fraudulent activities in federal healthcare programs.
This article is reproduced from: https://www.justice.gov/opa/pr/gamma-healthcare-and-three-its-owners-agree-pay-136-million-allegedly-billing-medicare-lab
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Gamma Healthcare Inc. Fraud Settlement $16 Million False Claims Resolution Medicare Billings Dispute Overview Unnecessary Lab Tests Allegations False Claims Act Violation Case Poplar Bluff Laboratory Misconduct