Park Square Urgent Care: Billing the Complexity the Laboratory Could Not Perform

In the Park Square Urgent Care settlement, the providers agreed to pay $650,000 over allegations that they billed Medicare and Medicaid for urine drug screening tests their laboratories could not perform. The government alleged that the labs could run simpler tests but knowingly billed for more complex, more expensive screening. The equipment, the government said, could do one thing. The claims represented something else.

Park Square Urgent Care was among the Rhode Island medical providers accused of billing beyond their laboratories’ capabilities. The Justice Department announced the civil settlement on June 14, 2021, resolving a case the government brought in federal court in Rhode Island. The government alleged that the providers acted under a physician’s direction. The Department of Health and Human Services’ Office of Inspector General investigated the case.

The allegations concerned tens of thousands of claims against Medicare and Medicaid. Taxpayers were being asked to fund testing the laboratories allegedly lacked the equipment to perform. The Justice Department said the settlement amount reflected an extensive review of the defendants’ financial condition and ability to pay.

What the Laboratories Could Actually Perform

The government alleged that the laboratories lacked the equipment or capability to perform the urine drug tests for which they sought reimbursement. The simpler tests they could perform carried lower reimbursement rates.

For someone familiar with the laboratory’s capabilities, the allegation was concrete: the service described to Medicare and Medicaid exceeded what the laboratories could do.

A laboratory’s certificate identifies the testing it may perform. The rules implementing the Clinical Laboratory Improvement Amendments also address personnel, quality systems and records. That makes the certificate relevant to a claim about testing beyond a laboratory’s capabilities, alongside the equipment and method actually used.

How a Claim Can Outrun the Test

In Park Square’s case, the government alleged a gap between the simpler drug screens the laboratories could perform and the more complex, more expensive drug screens they billed to Medicare and Medicaid.

The Records Behind the Billing Decision

The clinician’s order, the laboratory’s method and the billed service give us a way to examine a suspected capability mismatch with the insider who knows the work. Someone at the bench may recognize the limits of the equipment, while someone handling claims may know how that work was described to the payer. We bring that technical knowledge and the billing decisions together to build the case.

The Pattern Across Toxicology Cases

In its 2019 settlement with LabTox, the government alleged high-complexity urine testing claims for a low-complexity method.

The laboratory’s method, the scope of testing and the clinician’s order each describe something the claim should represent accurately. An employee may know exactly where that description diverged from the work. That knowledge gives us a specific place to begin assessing a health care whistleblower case. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know What the Laboratory Could Do

If you saw claims for testing your laboratory could not perform, talk with our whistleblower experts about the gap between the work and the bill. We build your strongest laboratory fraud whistleblower case with you and bring in healthcare whistleblower lawyers who understand testing methods and Medicare and Medicaid claims. From the first account of the laboratory’s capabilities through the pursuit of a recovery, we stay on your side.