Lab Fraud Update

Labs: Watch for Whistleblowers! You Can’t Predict Who’s Filing

Whistleblowers aren’t just lab employees or insiders, but include physicians and even HMO med directors

NEWS STORIES ABOUT TWO DIFFERENT FEDERAL WHISTLEBLOWER CASES against lab companies provide a reminder that managers of every clinical laboratory and pathology group must be vigilant about compliance, because potential whistleblowers can emerge from the unlikeliest of places.

The first example involves Piedmont Pathology in Hickory, N.C. In May, it agreed to pay the federal government $601,000 to settle allegations of submitting false claims. The qui tam case was filed by pathologist Kim Geisinger, MD, who previously worked at Piedmont Pathology from March 2012 through February 2014. The whistleblower received 20%, or $120,000, of the settlement amount.

The lawsuit claimed that Piedmont “lacked medical necessity for the special stains conducted on certain gastric biopsies before a pathologist reviewed the routine H&E stained specimen.”

Surprisingly, this wasn’t the first time this pathology group had to deal with a whistleblower lawsuit. In November, 2015, Piedmont Pathology Associates, Inc., and Piedmont Pathology, PC, agreed to settle a different qui tam case and pay the federal government $500,000.

In the Dept. of Justice press release, it stated that, “The government found that Piedmont Pathology provided EMR software licenses at little to no cost to nine physicians’ practices close in time to when those practices entered contracts to refer specimens to their pathology lab. This conduct violated the Anti-Kickback Statute.”

The press release described the whistleblower as “a former contract salesperson for the practice.” This individual received 15%, or $75,000, from the proceeds of the settlement.

Insurer’s Medical Director

The second example is a whistleblower case against Boston Heart Diagnostics Corp. (formerly Boston HeartLab). Filed in 2015, the case is still under litigation.

The allegations are that the lab company performed certain genetic and non-genetic tests that were medically unnecessary for specific diagnostic codes.

What is noteworthy in this case is that the whistleblower is a medical director for a national health insurance company. Tina D. Groat, MD, is one of the plaintiffs and is the National Medical Director of Women’s Health and Genetics at UnitedHealthcare.

These federal qui tam lawsuits demonstrate that all labs are being watched for illegal behavior, not just by insiders and employees, but by healthcare professionals outside the lab. The cases show how even outsiders have enough access to documents and the motivation to initiate a successful whistleblower lawsuit.

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