UC San Diego Health: Ordering Unnecessary Genetic Tests From Outside Labs

The $2.98 million UC San Diego genetic testing settlement resolved allegations that UC San Diego Health ordered medically unnecessary genetic tests that outside laboratories billed to Medicare. According to the government, the health system directed the testing, the laboratories performed it, and taxpayers picked up the bill. For someone who works with genetic test orders or referrals, the case puts the clinical decision at the center of the billing story: why did this patient need this test?

The Department of Justice announced the payment on January 11, 2022. UC San Diego Health is the academic health system of the University of California, San Diego. The alleged conduct ran from December 2015 through October 2019.

Outside Laboratories, a Health System’s Orders

UC San Diego Health allegedly ordered and submitted referrals for medically unnecessary genetic testing performed by CQuentia Arkansas Labs, CQuentia NGS and Total Diagnostic II. The settlement agreement calls them the CQuentia labs and identifies them as the entities that presented the resulting claims to Medicare.

The government’s case against the health system concerned the orders and referrals that allegedly caused the labs’ claims. The decision that mattered to Medicare payment began inside the health system, before the specimen reached an outside lab.

The Regents of the University of California entered the settlement agreement on behalf of UC San Diego Health.

The Justice Department’s explanation was direct: hospitals are gatekeepers for medical care and should ensure that services performed at their direction are medically appropriate. Sending a specimen outside the hospital leaves the reason for ordering the test inside it.

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

Other Genetic Testing Cases Turned on the Patient’s Need

Separate genetic testing settlements show why patient-specific support matters. In the GenomeDX Biosciences settlement, the company agreed to pay $1,990,380 over allegations that it billed for its Decipher prostate cancer test without the patient risk factors supporting it.

Millennium Health’s resolution included a $10 million component for alleged medically unnecessary genetic testing. That component addressed genetic tests within a broader resolution that also concerned urine drug testing and related administrative matters.

In each account, the medical need for the testing mattered to the payment allegation. UC San Diego Health’s settlement brought that question to the ordering and referring organization.

You Know Why the Test Was Ordered

If you know why unnecessary genetic tests were ordered, speak to one of our whistleblower experts about your strongest laboratory fraud case. We build the case around your knowledge of the clinical and billing decisions, bring in healthcare fraud whistleblower lawyers who understand laboratory referrals, and stay beside you through the pursuit of a recovery.