Pacific Toxicology Laboratories Agrees to Pay $1 Million to Resolve Allegations of Fraudulent Billing

BOSTON – A California-based laboratory, Pacific Toxicology Laboratories (PacTox), has agreed to pay $1 million to resolve allegations that it submitted false claims for payment to Medicare for urine drug testing (UDT).

On Jan. 1, 2020, Medicare established regulations for payment to Opioid Treatment Programs (OTPs) for opioid use disorder (OUD) treatment services for Medicare beneficiaries.  Medicare established a bundled payment rate for OTPs’ provision of OUD treatment services, including, but not limited to, dispensing and administering opioid treatment medications (such as Methadone), substance use counseling, individual and group therapy services, intake activities, periodic assessment services and UDT. Pursuant to the bundled payment rate methodology, Medicare makes one all-inclusive payment for the treatment services, including UDT.

According to the settlement agreement, PacTox admits that between Jan. 1, 2020 and March 14, 2023 PacTox separately billed Medicare for confirmatory UDT, notwithstanding the bundled payment rate made applicable by Medicare regulations. The United States alleges that PacTox’s practice of separately billing for UDT for OTP patients resulted in Medicare paying twice for UDT services for certain OUD patients.

The claims resolved by the resolution announced today include claims that were brought under the qui tam or whistleblower provisions of the False Claims Act. Under the Act, a private party can file an action on behalf of the United States and receive a portion of any recovery. As part of today’s resolution, the whistleblower will receive approximately $200,000.

Acting United States Attorney Joshua S. Levy; Robert Coviello, Special Agent in Charge of the Department of Health and Human Services, Office of the Inspector General; and Jodi Cohen, Special Agent in Charge of the Federal Bureau of Investigation, Boston Division made the announcement today. Assistant U.S. Attorney Abraham R. George, Chief of the Civil Division, handled the matter.