Dominion Diagnostics: Standing Orders and Unrequested Tests

Dominion Diagnostics paid $815,000 to the United States and Vermont to settle allegations over specimen-validity tests that physicians had not specifically ordered and a separate Medicaid billing-rate practice. The December 2017 civil settlement announcement covered the testing allegations from January 1, 2010, through December 23, 2015. Dominion did not admit liability.

Standing Orders Automatically Added Validity Tests

Federal and state authorities alleged that Dominion’s standing orders automatically included specimen-validity tests without considering whether the referring physicians had ordered them. Dominion then sought payment from Medicare and Vermont Medicaid. Specimen-validity testing examines the integrity of the sample; here, the disputed step was adding it to the work billed without a specific physician order.

For someone who works with requisitions or billing, the comparison starts with the physician’s request and the tests selected by the laboratory’s standing order. A default selection can turn into a claim even when the physician never made that selection.

In its civil settlement announcement, the Department of Justice reported that Genotox Laboratories admitted offering profiles that preselected tests across a provider’s patients.

A Rate Applied to Earlier Claims

Vermont also alleged that Dominion adopted a new usual and customary rate and improperly applied it retroactively to claims submitted to Vermont Medicaid. That billing allegation concerned the rate used on earlier claims, separately from the automatic addition of specimen-validity tests.

Pacific Toxicology Laboratories settled allegations that separate urine drug testing bills for opioid treatment program patients duplicated Medicare payments already included in the treatment bundle.

Dominion’s Separate Whistleblower Case

Dominion had also brought its own whistleblower case against Calloway Laboratories, AIT Laboratories and Ameritox. Its complaint alleged that free collection staff, cups and testing arrangements steered referrals to competing laboratories. That earlier complaint is separate from the Vermont settlement over Dominion’s own billing.

What Lab and Billing Staff See

The useful account connects the requested test to the test performed, the result reported and the claim submitted. A phlebotomist, laboratory technical director, medical assistant or billing employee may see a different part of that chain. Their knowledge becomes more useful when the pieces describe the same specimen.

For an automatic add-on, we examine the physician’s request alongside the standing order or profile that selected the additional work. We then connect that selection to the result and the bill. Here, the government challenged validity tests added without the referring physician’s specific order.

Referral arrangements add another part of the account: the cups, collection personnel and services offered to the practice. Dominion’s complaint shows how a laboratory competitor can recognize those benefits. Someone inside the practice may know what staff actually did, while someone in billing may know which payer received the resulting claim.

A whistleblower case under the False Claims Act can pay 15% to 30% of what the government recovers. We work with you on what your knowledge of the laboratory business can establish, from the original test request to the decisions that generated the bill.

You Know How the Test Reached the Bill

If you know how a standing order added tests or how a referral arrangement changed the work billed, speak to our whistleblower experts about how the tests reached the bill. We build the case with you and bring in laboratory fraud whistleblower lawyers who understand test ordering and payment. We stay alongside you, turning your knowledge of the specimens, the accounts and the billing into your strongest laboratory fraud whistleblower case.