BestCare Laboratory Services: The Mileage Between the Log and the Bill

In the BestCare nursing home mileage fraud case, the laboratory and its owner agreed to pay an additional $5.7 million toward an outstanding judgment for false Medicare travel claims. For someone who knows the collection routes or the billing system, the government’s complaint shows the discrepancy in terms a technician would recognize: the distance on the day’s log and the distance on the bill.

How the Nursing Home Mileage Claims Worked

BestCare Laboratory Services LLC was a Texas clinical laboratory that billed Medicare for technician travel to collect specimens from nursing home residents. According to the government’s complaint, the mileage claims could describe a trip that nobody took. Specimens moved by air, while the bills treated their movement as technician travel:

The shipment had a route. The claimed technician did not travel it.

The complaint also compared a technician’s own log with the claims for her route. She recorded 69 miles covering four nursing homes that day. BestCare allegedly claimed 676 miles for the same route. In another example, the government alleged claims for more than 4,000 miles of technician travel in a day when no such travel occurred. Medicare was being billed for a day of driving that never happened, with taxpayers paying for the invented miles.

The alleged method varied. Sometimes BestCare billed a hypothetical one-way journey and sometimes a round trip. Sometimes it divided that hypothetical mileage among the patients served, and sometimes it did not.

The government’s complaint extended the same allegation to specimens tested at BestCare’s Dallas and San Antonio satellite laboratories or at outside contract laboratories. It alleged that the owner instructed staff to bill as though technicians had returned those specimens to the Webster laboratory.

The complaint identified P9603 as the code for BestCare’s technician travel allowance claims. It alleged that Medicare paid BestCare more than $24 million under that code from 2004 to 2009. For the majority of those claims, the government alleged that technicians had not traveled the billed mileage, that the mileage had not been divided among patients, and that it was unreasonable. The allegation reached the method behind the claims, beyond any single technician’s daily log.

The Same Trip Billed for Each Resident

The earlier LabCorp nursing home mileage case shows why dividing a trip among patients matters. In that case, the whistleblowers’ complaint alleged full round-trip mileage for each resident at a single nursing home, although the travel expense should have been shared among them. It also alleged claims for travel expenses the laboratory had not incurred for independent contractors.

The LabCorp complaint also alleged that technicians were told to record mileage codes without regard to where their trip began or where it ended. The endpoint could be a laboratory or a collection point where a courier picked up the samples. The whistleblowers alleged that the codes ignored the actual travel and were not divided among patients. Those instructions explain how a billing system could erase the route the technician actually drove.

For an insider, the relevant comparison is the whole collection route against all the claims generated from it.

What Evidence Is Needed to Prove Fraud?

For nursing home laboratory mileage, the useful evidence connects the technician’s actual route, the specimen’s movement, the billing instructions and the Medicare claim. BestCare’s complaint supplies that comparison directly through the route log, the air shipment and the instruction to bill hypothetical travel. Those are the connections we examine with a laboratory or nursing home insider.

For outside health care services, we would connect the nursing home’s orders and staff schedules to the laboratory’s collection logs and billing records. In this case, that comparison starts with the technician’s recorded visits and follows the specimens to the place they were tested.

We would compare the P9603 claim lines with the collection logs and specimen shipping records, then examine the instructions used to produce the mileage. A laboratory employee may understand the billing method. A technician may know the route. Someone handling specimens may know where the samples went. Their accounts address different parts of the same claim.

The return-to-Webster instruction gives that assessment a concrete starting point. We would examine how staff chose the billed destination when the specimen was tested at a satellite or contract laboratory. We would also examine how they assigned miles to each patient on a shared route. An insider who understands those decisions can help connect an inflated claim to the instruction that produced it, rather than leaving the discrepancy as an unexplained number in a billing file.

The 2018 Journal of Forensic & Investigative Accounting paper Pressure to Commit Fraud in the Workplace: Two Teaching Cases Addressing Fraud and Whistleblower Protection reports a fraud-examiner survey finding that fraud was most often detected through tips from employees, vendors and customers. Someone who knows the collection work can explain why a billed journey makes no sense.

A Court Finding and a Separate Whistleblower Reward

The court entered a False Claims Act judgment in 2018 after finding that BestCare knowingly submitted false Medicare mileage claims at its owner’s direction. The Justice Department’s account places responsibility in the instruction behind the billing, as well as in the claims themselves. That is why the person who knows how the mileage method was chosen can matter alongside the person who knows how far a technician drove.

BestCare and its owner and founder agreed to the additional payment terms the Justice Department announced on August 1, 2023. The agreement addressed that outstanding judgment. The United States had already collected $789,652 since the judgment, separate from the new scheduled payments.

A whistleblower brought the original qui tam case in 2008, and the government joined it in 2011. The later collection announcement said the whistleblower would receive a $1.3 million reward in connection with the agreement.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers.

You Know Which Miles Were Traveled

If you know why a laboratory’s mileage claims do not match its collection work, speak to one of our whistleblower experts about the miles that were never driven. We work with you to build the case around the routes, the claims and the people directing the billing, and bring in healthcare fraud whistleblower lawyers who understand laboratory reimbursement. We stay with you through the case to build your strongest laboratory mileage whistleblower case.