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[MM Curator Summary]: The urine test scam means that $700K in FL Medicaid bucks was just p*ssed away.
Tampa, Florida – United States Attorney Roger B. Handberg announces today that Physicians Group Services, P.A. (“PGS”) has agreed to pay the United States and the State of Florida $700,000 to resolve allegations that PGS violated the False Claims Act by submitting false or fraudulent claims to the Florida Medicaid Program, which is a state and federal partnership that provides access to health care coverage for low-income families and individuals in Florida.
The United States’ investigation focused on urine drug testing (“UDT”) by PGS. UDT occurs in a variety of health care settings. In a pain management practice, UDT is used to monitor whether a patient is taking prescribed drugs, is taking non-prescribed drugs, or is consuming with prescribed drugs other dangerous substances, such as alcohol. UDT is either “qualitative” or “quantitative.”
The clinical value of quantitative UDT depends in part on whether the qualitative UDT result is expected or unexpected, as well as the patient’s history of drug abuse, history of medication adherence and compliance, clinical presentation, and medical history. The settlement announced today resolves allegations that PGS submitted claims to Florida Medicaid for quantitative urine drug testing, which claims the United States and the State of Florida allege were medically unnecessary because the testing was not individualized to the particular needs of the patient.
“A primary mission of the United States Attorney’s Office is protecting the Medicaid program and other federal health care programs from fraud,” said U.S. Attorney Roger Handberg. “Our Civil Division works tirelessly in the pursuit of providers who overbill federal health care programs through indiscriminate testing.”
“Health care providers that submit fraudulent claims to Medicaid for medically unnecessary services undermine this safety net program for their own personal gain,” said Special Agent in Charge Omar Pérez Aybar with the U.S. Department of Health and Human Services Office of Inspector General. “We continue to work tirelessly with our law enforcement partners to protect the integrity of federal health care programs and to ensure the appropriate use of U.S. taxpayer dollars.”
Attorney General Ashley Moody said, “My Medicaid Fraud Control Unit is committed to stopping fraud that bilks the Medicaid program and takes advantage of our taxpayers. I am proud of my Medicaid Fraud Control Unit for working with our federal partners to secure this action.”
Today’s settlement results from a coordinated effort by the U.S. Attorney’s Office for the Middle District of Florida, the Department of Health and Human Services Office of Inspector General, and the Florida Attorney General’s Medicaid Fraud Control Unit. Assistant United States Attorneys Lindsay Saxe Griffin and Sean Keefe led the civil investigation.
The claims resolved by the settlement are allegations only, and there has been no determination of liability.