IT’S A REMINDER THAT WHISTLEBLOWERS continue to look for opportunities to turn in laboratories, even if the violations are relatively minor.
Last month, Dianon Systems Inc., of Stratford, Connecticut, agreed to pay $1.5 million to settle a federal false claims action originally filed by pathologist James J. Tiesinga, M.D., who once worked for Dianon in its Connecticut facility. Tiesinga will be paid $300,000 from the $1.5 million settlement.
Medically Unnecessary Tests
According to the settlement agreement, Tiesinga worked for Dianon as a hematopathologist from July 2001 until June 5, 2002. On Sept. 6, 2002, Tiesinga filed a qui tam action against Dianon. The federal government entered the case on behalf of Medicare and Tricare, the healthcare program for military personnel and their families.
From January 1, 1996, to December 31, 2003, Dianon submitted claims to Medicare and Tricare for flow cytometry services, billed under CPT code 88180, that were not medically necessary, the settlement agreement says. Also, from January 1, 1996, to August 30, 1997, Dianon submitted claims to Medicare and Tricare for 26 units of flow cytometry services while performing only 22 units of flow cytometry services.
The amount of the settlement, compared to other past lab settlements with the federal government, shows that the business practices in dispute did not involve high volumes of tests. Further, these Medicare claims originated in the years before Dianon Systems was acquired by Laboratory Corporation of America in early 2003.
Tiesinga’s attorney, Joseph Maya, of Maya and Associates, of Westport, Connecticut, told THE DARK REPORT that neither he nor Tiesinga could comment on the case. A spokesman for U.S. Attorney Kevin J. O’Connor, the U.S. Attorney in Connecticut, also declined to comment. Since federal attorneys usually like to talk about the details of successful legal actions, it is likely that this settlement was based on relatively minor infractions or operational processes that failed to meet compliance requirements.
What this case represents is a reminder to laboratories of their exposure to whistleblowers among their employees and staff. The interesting question raised by this case is how Dianon’s internal compliance system responded if whistleblower Tiesinga—who worked there less than 12 months—followed the company’s compliance policies. One of the primary purposes of a lab’s compliance program is to create communication channels that employees can use to alert the company to practices that may be non-compliant. Then the company has the opportunity to address and correct those practices. It also should then notify government health programs of any improper claims so that corrective action can be taken.
Qui Tam Exposure
Whistleblower Tiesinga’s $300,000 payment as his share of the $1.5 million settlement illustrates what continues to motivate employees to become whistleblowers. It is a timely reminder that labs should review their compliance program and how employees use it.