Federal Way Physician Drug Testing: Drug Tests Not Performed or Completed Too Late to Help

The physician who owned Family Medicine Clinic of Federal Way LLC agreed to pay $228,000 in a laboratory settlement over allegations that he billed Medicare and Medicaid for urine drug tests never performed or performed too late to be useful. He was the sole owner and operator of the practice, which had its own certified laboratory. The government alleged that testing equipment sat broken for long periods while samples went into the freezer and bills went to government health programs. For someone who worked at the bench or handled the billing, that is a recognizable split between the service on the claim and what happened to the specimen.

The Justice Department announced the settlement on January 14, 2022. The physician practiced general medicine in Federal Way, Washington.

Can a Physician Have a Urine Drug Testing Lab in the Office?

Yes. Family Medicine Clinic of Federal Way had a certified laboratory capable of performing urine drug tests. According to the Justice Department’s account of the settlement, its purpose was to screen patients for appropriate prescribing of medications, including substance use disorder treatment. The prescribing practice and the laboratory were under the same roof.

Urine drug screening can help a physician understand whether a patient is taking prescribed medication and whether other substances are present. The 2014 Pain Physician paper Ethical Perspectives on Urine Drug Screening for Pain Physicians describes its use in monitoring medication adherence and informing further care.

The alleged failure was inside the business that needed the results for its own patients. The practice collected urine to guide prescribing, yet the government alleged that it billed for tests it could not perform while the equipment was broken.

What Is an Example of Laboratory Fraud?

Billing for a urine drug test that was never performed is an example of laboratory fraud alleged in the Federal Way settlement. The government identified a billing period from January 1, 2019, through July 30, 2019. It said the physician submitted claims to Medicare and Medicaid while urine-testing equipment was broken for long stretches.

The government alleged that the clinic froze samples for later testing and never tested some of them at all. The specimen had reached the clinic, but the billed laboratory service had not happened. For those claims, the missing result was the consequence of missing work.

The second allegation concerned tests performed too late to be useful. That failure is different: a laboratory can eventually produce a report after the opportunity to use it in care has passed. A completed result does not answer the question of when the clinician had it.

The distinction matters to both sides of the clinic. Laboratory staff may know which samples remained untested. Clinical staff may know when a prescribing decision needed the result. Billing records connect those different views to the service the health program paid for.

The Result Has to Reach the Prescribing Decision

The usefulness of a urine drug test depends on what it can tell the treating clinician and when that information arrives. In Federal Way, the government’s allegation was that some billed tests reached that point too late.

The Journal of Family Practice’s 2021 article Urine Drug Screening: A Guide to Monitoring Tx With Controlled Substances describes drug testing as:

Keeping a sample for later testing postponed the answer the clinic had collected it to obtain. Our question in a case like this is whether that answer was available for the prescribing decision it was supposed to inform. Patients needed information for treatment. The government alleged that health programs instead paid for testing that was never done or came too late to help.

What the Civil Settlement Required

The physician agreed to repay $76,000 to government medical programs without admitting the allegations. The Justice Department said the False Claims Act allowed the government to seek additional damages, resulting in another $152,000 to be paid over the following year. The civil payment combined repayment of the billed amounts with additional damages for the same conduct.

What the Laboratory and Billing Staff Could See

Broken-equipment records, specimen testing dates and the corresponding claims are the case-specific records we would examine with an insider. Together, they can connect the laboratory’s ability to perform a billed test with what happened to the sample. The treatment decision gives that comparison its clinical purpose.

Model Plan Helps Laboratories Fight Fraud, published in Laboratory Medicine in 1997, described federal compliance recommendations to retain and analyze test-use data and audit laboratory operations. Applied to the Federal Way allegations, the point is concrete: the account of work at the bench has to explain the work represented on the bill.

A technician who knows when an instrument stopped working may see something the claim does not show. A billing employee may see claims associated with those same testing dates. Our work is to connect that knowledge to the government’s payments and the decisions inside the business, so a laboratory fraud case rests on what actually happened. A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Saw What Happened to the Samples

If you worked with frozen specimens, broken testing equipment or claims for tests that never happened, tell our whistleblower experts what you saw. We connect your knowledge of the laboratory to the billing and prescribing decisions, build the case with you, and bring in laboratory fraud whistleblower lawyers who understand urine drug testing. We stay with you through the whole journey to build your strongest laboratory fraud whistleblower case.