tci Medicare Compliance & Reimbursement - 2023 Issue Q3

Industry Notes: Feds Settle FCA Allegations for $6.5 Million

Case serves as a stern reminder on medical necessity. Over the past few years, the feds have repeatedly targeted fraudulent urine drug testing, so this case shouldn’t surprise you — but the settlement numbers might. Details: On Aug. 24, Detroit-based physician Rajendra Bothra and two entities that he owned, the Pain Center USA, PLLC, and Interventional Pain Center, PLLC, agreed to pay more than $6.5 million to settle False Claims Act (FCA) allegations. Between 2015 and 2018, Bothra and the two other defendants billed Medicare and Medicaid for medically unnecessary urine drug tests and additional lab work...

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