Ellington Behavioral Health: Multiplied Urine Screens and Delayed Tests

Ellington Behavioral Health and its psychiatrist owner agreed to an $805,071 civil settlement in the Waire fraud case over allegations that they multiplied Medicare urine-screen units and billed Medicaid for tests performed late or never performed. For someone who handled samples, treatment records or billing, the case turns on a familiar divide: what happened to the specimen and what the claim said.

Waire LLC did business as Ellington Behavioral Health, a psychiatric medical practice in Ellington, Connecticut. The practice regularly screened urine collected from patients receiving treatment for substance use disorders. The U.S. Attorney’s Office for the District of Connecticut and the Connecticut Attorney General announced the settlement with the practice and its owner on May 14, 2018.

Medicare Urine Screens Billed More Than Once Per Encounter

The Medicare allegation concerned multiple units billed for a urine screen that Medicare treated as one test per patient encounter. The covered Medicare claims ran from January 1, 2011 through September 30, 2013.

The government’s explanation starts with the sample. A urine screen can test a single sample for multiple classes of drugs. For the screening described in this case, Medicare treated that work as a single test, billable once per encounter. Several drug classes did not create several payable encounters.

The government alleged that Ellington and its owner submitted multiple units when they knew or should have known that only one unit could be billed. According to the announcement, that coding brought them hundreds of thousands of dollars in Medicare payments they were not entitled to receive. Taxpayers were paying for the alleged multiplication on the claim.

For a billing employee, the important comparison is the encounter against the quantity submitted for payment. We would connect that difference to the billing decisions inside the practice: how the quantity was chosen, who directed it and what they understood the payer would cover.

Medicaid Samples Tested Weeks or Months Later

The Medicaid allegation concerned whether testing happened and when. The government alleged that Ellington and its owner billed for urine drug screens even though samples were never tested or were tested weeks or months after collection. The covered Medicaid claims ran from January 1 through June 30, 2014.

Here, the gap was between collecting a specimen and performing the test billed to Medicaid. The date a patient supplied urine and the date someone tested it could tell very different stories. A worker handling the samples would see one part of that sequence. The person submitting the claim might see another.

Why the Test Result Matters to Treatment

The 2016 article How Urine Drug Testing Fraud and Abuse Is Impacting the Treatment Community, published in BNA’s Health Care Fraud Report, describes quick point-of-care screening and laboratory confirmation as different testing methods. It also emphasizes a physician’s documented reason for ordering a test and the review of its results in ongoing treatment.

That clinical purpose makes the delay allegation worth more attention than a billing headline gives it. We want to understand when the result became available and how it entered the patient’s care, alongside what the payer was charged. The test’s place in treatment helps explain why the timing matters to the people working in the clinic.

The Pattern Around Urine-Test Billing

The Connecticut Behavioral Health Associates settlement addressed allegations of multiplied Medicare urine-screen units and Medicaid definitive testing that never occurred, a close comparison to Ellington’s two billing defects: the number of units claimed and whether the testing was done.

What Evidence Does a Whistleblower Need?

For urine-screen billing, useful evidence connects the encounter, the work actually performed, the testing date and the claim sent to the payer. We help you identify which records explain the gap in a health care practice’s billing.

A biller may understand how a single encounter became multiple units. A staff member who handled specimens may know when samples reached testing or remained untested. A clinician may know when results became available for review. We work with those different views to connect the healthcare work to the money requested for it, and to the decisions that explain the mismatch.

A former employee brought the whistleblower case against Ellington and its owner.

How Much of a Settlement Does a Whistleblower Get?

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

In Ellington’s case, the government announced that the former employee would receive a share of the settlement proceeds.

You Know What Happened to the Sample

If your work showed a gap between the urine testing performed and the claims submitted, speak to one of our Whistleblower Experts about what you saw. We build the case with you and bring in behavioral health fraud whistleblower lawyers who understand laboratory billing and treatment records. From the first conversation through the pursuit of a recovery, we stay beside you and build your strongest behavioral health whistleblower case.