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The academic health system of the University of California, San Diego, agreed to pay almost $3 million over allegations of using Medicare to fund “unnecessary genetic testing.”
“UC San Diego Health, the academic health system of the University of California, San Diego, has paid $2.98 million to resolve allegations that it violated the False Claims Act by ordering medically unnecessary genetic testing reimbursed by Medicare,” according to the Justice Department.
While the allegations about misusing Medicare money were never officially adjudicated, the payment will bring a conclusion to the allegations. The UC San Diego Health allegedly “ordered and submitted referrals” for CQuentia Arkansas Labs, CQuentia NGS, and Total Diagnostic II to produce unneeded genetic tests from 2015 to 2019.
Investigators claim that this led to false claims being made for Medicare to pay for the testing.
“Ordering unnecessary genetic tests creates a drain on vital government-funded health care programs like Medicare,” U.S. Attorney Randy Grossman said. “This settlement is another example of this office’s commitment to work with our law enforcement partners to hold medical providers accountable when their conduct leads to taxpayers bearing the cost of improper billing practices.”
The investigation spanned multiple agencies including the FBI, the Department of Health and Human Services, the Southern District of California’s attorney’s office, and the Civil Division’s Commercial Litigation Branch.
Acting Assistant Attorney General Brian M. Boynton of the Justice Department’s Civil Division said that hospitals had a responsibility to make sure that everything they did was “medically appropriate.”
“Hospitals are the gatekeepers for medical care and are expected to ensure that all services performed at their direction, including genetic tests, are medically appropriate,” Boynton said. “The department will continue to pursue those who undermine the integrity of federal health care programs and waste taxpayer dollars.”
A spokeswoman for UC San Diego Health said that the hospital “fully cooperated and promptly resolved the matter,” according to the San Diego Union-Tribune.
“Working at the forefront of patient care sometimes involves the use of new technologies from emerging companies. When UC San Diego Health learned that the Department of Justice had concerns about one of our technology providers, we fully cooperated and promptly resolved the matter,” spokeswoman Jacqueline Carr said. “The DOJ’s settlement announcement alleges that our doctors ordered tests from a company that then allegedly made false claims about those orders.”
Carr noted that the hospital system, “remains committed to integrating the leading best practices and technology into our research, teaching and patient care missions, in accordance with the highest standards of ethical conduct and all applicable laws and regulations.”
The Union-Tribune also reported that it seems as if CQuentia, headquartered in Tennessee, is no longer open. The company has faced a lawsuit involving false claims as recently as 2017.
Federal investigators noted how false claims and medical fraud diminish trust in hospitals and the healthcare industry.
“False claims diminish trust in our health care while generating enormous unnecessary costs and the FBI is proud to work alongside our federal partners to disrupt such schemes,” FBI Special Agent Suzanne Turner said.