Polaris Allergy Labs: Invented Results to Save on Testing

The owner of Polaris Allergy Labs in East Point pleaded guilty to health care fraud after inventing results for allergy tests that patients’ doctors had ordered. In its announcement of the criminal guilty plea, the Department of Justice described how the owner skipped testing to save money, sent fabricated reports to doctors and arranged billing to patients’ health plans anyway. An insider who knew what happened to the blood would have a very different account from the one the doctor received.

Allergy Tests Skipped to Save Reagents

The Department of Justice’s guilty-plea announcement describes the owner’s instruction to a laboratory technician: leave some blood samples untested to save the allergen reagents needed to analyze them. The owner had opened Polaris Allergy Labs in East Point, Georgia, in 2011. Doctors sent patients’ blood there for food and environmental allergy testing.

Beginning in approximately September 2012 and continuing through February 2014, the owner directed the technician to skip testing some samples. He then created fake allergy reports and had them sent back to the ordering doctors. The physician’s request still produced a report, even though the laboratory had omitted the work that would give the report meaning.

Positive and Negative Results Chosen to Avoid Suspicion

The owner invented both positive and negative allergy results to keep doctors from becoming suspicious. The guilty-plea announcement says he sometimes reported an allergic reaction and sometimes reported none. The doctors did not know that the results had been made up. The Department of Justice said many of the affected patients were children and the elderly.

A negative result was part of the disguise too. The owner varied the answer to make the reports believable, while the blood that should have supplied the answer went untested.

The report also led to a bill. After making up a patient’s result, the owner arranged billing to the patient’s health plan for a test nobody ran. Patients got allergy answers nobody had tested, and their health plans got the bills.

The Department of Justice’s January 9, 2015 announcement in the criminal case added that investigators had notified the doctors and patients potentially affected by the fraudulent testing. It also confirmed the owner’s guilty plea on July 22, 2014. The notification followed the same path as the false information: back to the people whose care depended on the reported results.

What Evidence Is Needed to Prove Fraud?

For fabricated laboratory results, we work with an insider to connect the doctor’s order, the sample, the bench work, the report and the bill. In the Polaris criminal case, the owner’s instruction to skip testing supplies a further connection: why the work stopped while the reports and claims continued.

The 2010 Spectroscopy Magazine article Fat Finger, Falsification, or Fraud? calls for linking laboratory instruments with data systems that track changes to results:

The article says laboratory data should show who performed the work and when. It calls for supervisors and quality staff to review the changes recorded in audit trails.

Applied to a report like the ones in this case, that means asking what analytical work produced the reported answer. A final report gives the doctor a conclusion. The underlying records explain who generated it, from which sample, and when. An employee’s knowledge of instructions to omit testing can connect those records to a deliberate business decision.

Someone at the bench may know which work was skipped. Someone issuing reports may know how results appeared. Someone handling claims may know what the laboratory billed. Our work with an insider is to connect those views to the same testing episode and the people directing it.

The Order and the Claim Live in Different Places

The ordering practice and the billing laboratory can hold different parts of the same healthcare transaction. Under Medicare’s documentation rules for diagnostic tests, the doctor’s office keeps the record explaining why the test was needed. The billing laboratory keeps what the doctor sent and records showing that its claim matches that information.

That industry separation helps explain why a false result can travel so far. At Polaris, doctors sent blood for testing and received reports while remaining unaware that the owner had fabricated the answers. The practice’s record of requesting a test and the laboratory’s record of reporting one could coexist while the actual testing was missing.

Fabricated Results, Faulty Devices and Unsupported Tests

Other laboratory cases show why the source of a false result matters. The Department of Justice’s account of Magellan Diagnostics’ criminal case describes the company’s guilty plea over concealing a malfunction in lead-testing devices. There, the problem began with the testing equipment and what the manufacturer concealed. At Polaris, the owner deliberately omitted tests and invented the results himself.

Allergy billing can also turn on what management knew about the need for a test. In the whistleblower complaint against Genova Diagnostics, the company’s chief medical officer allegedly recommended that management stop billing Medicare for allergy testing because the necessary clinical evidence was lacking. The complaint describes the response:

That allegation concerns the decision to keep billing after a warning about medical necessity. It offers an insider a different connection between management’s knowledge and the claims that followed.

In a separate complaint against Princeton Pathology Services, a physician alleged that his own emergency-room visit exposed charges for tests his treating physician had never ordered and that he had never undergone.

What Your Knowledge of the Laboratory Can Reveal

A specific instruction, a report you know was invented, or a claim for testing you know never happened gives us a concrete starting point. We work with that knowledge to assess a potential laboratory fraud case.

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

You Know Whether the Test Was Run

If you saw results created without testing or bills sent for work the laboratory skipped, speak to one of our Whistleblower Experts about what happened inside the lab. We build your strongest laboratory fraud whistleblower case around what you know, find laboratory fraud whistleblower lawyers with the right testing and billing experience, and stay beside you through the pursuit of a recovery.