In a recent court case, Carolinas HealthCare Systems has been ordered to and agreed to pay $6.5 million due to the False Claims Act. The settlement is a way for the company to make restitution for unlawful billing practices. The allegations were brought forward by a whistleblower.
It is contended that the hospital system up-coded claims for urine drug tests so that they received higher payments. A former lab director brought the billing to light, claiming that the payments would have been lower, and accurate, if the hospital system had billed correctly.
Court documents say that, over a period of four years, the hospital system submitted claims for urine tests that were “high complexity” when they were actually “moderate complexity.” Because of this categorization, the system was paid about $80 more than they should have been for each claim submitted. The lab director who blew the whistle on the company will receive just under one-and-a-half million from the settlement.
The hospital system cooperated with the government in the case, but gave up and settled after two years. N.C. Attorney General Josh Stein called the behavior of the hospital system an “unacceptable waste of taxpayer dollars.” He further stated that it was something his office would not allow.
In its defense, Carolinas HealthCare Systems said that the case was not about their quality of care or even safety. It was simply a matter of interpretation of constantly changing billing guidelines. The system said that it takes compliance very seriously and outside consultants had advised them that they were in compliance. The state disagreed.
Moderate Versus High-Complexity Drug Screens
The difference between moderate and high-complexity drug screens lie in the way the urine is tested. In a moderate test, chromatography is not used. The national reimbursement average for these tests is $20. In a high-complexity drug screen, enzyme assay or immunoassay may be utilized. The national reimbursement average for these drug tests is $100. It is widely known among medical providers that there is a greater reimbursement when high-complexity tests are utilized.
For example, if a medical provider issues 100 urine drug screens, they will be reimbursed approximately $12,000. If the overhead is $6,000, the medical provider will make a profit of $6,000 after reimbursement is delivered. If a medical provider conducts 1,000 of these high-complexity tests, their possibility of profit rises to over $100,000.
When a person causes a car accident and seems to be intoxicated on any substance, they may be subjected to a urine test, which is tested by Carolinas HealthCare Systems or a similar organization. If you have been injured in a car accident in Charlotte, you have legal rights to compensation. We handle a variety of personal injury cases and are here for you. Call our team today to schedule an appointment for a free case evaluation and learn more about how we can assist you. You may be entitled to compensation for medical bills, lost wages and more.