Why Companies Providing Mobile Blood Draws or Diagnostics Should Be on High Alert
If you’re a health care professional or a medical executive, getting accused of Medicare fraud probably sounds like something that happens to other doctors or companies – the really bad ones.
But the reality is that mobile lab companies are a top target for investigators who are probing Medicare bills for evidence of fraud. And in many cases, the companies and providers’ only vice was administrative in nature: poor recordkeeping or a lack of familiarity with Medicare rules and procedures.
As mobile lab fraud defense lawyers, we are concerned that many providers are not taking adequate steps to protect themselves from a fraud accusation. By employing smart strategies now, providers will be better poised for an effective defense should their billing practices be called into question.
What Is Mobile Lab Fraud?
Mobile laboratory fraud is a type of health care fraud involving blood draws, urine screens, toxicology testing, diagnostic work, or other laboratory services that are performed outside of a hospital or traditional lab setting.
Most fraud cases involve “false claims” or invoices that are submitted to a federal benefits program, such as Medicare or Medicaid (or a private insurance company), in violation of the program’s policies or the law.
Common examples of mobile lab fraud include:
- Phantom billing (for services never actually provided)
- Double billing
- Submitting claims for services that are not covered by Medicare (e.g. lab work that was not ordered by a licensed U.S. physician)
- Providing medically unnecessary lab services and then billing CMS for them
Business arrangements can constitute health care fraud too. Health care providers may not, for example:
- Receive a kickback of any kind in exchange for referring patients for services
- Refer patients to facilities in which the provider has a financial interest
Fraud is a criminal offense, and Medicare investigators may choose to refer their findings to state and/or federal law enforcement for criminal prosecution.
More often, when Medicare auditors detect unusual billing patterns or evidence of false claims, they will institute civil enforcement proceedings (sometimes accompanied by the threat of prosecution). These cases lead to many of the multi-million-dollar settlements the DOJ negotiates with health care providers.
Parties accused in a mobile lab fraud case can include the company’s:
- Billing coordinators
- Lab specialists / technicians
- Business partners
What Is the Medicare Fraud Strike Force?
The Medicare Fraud Strike Force is a collaborative effort involving numerous federal, state, and local law enforcement agencies. These organizations pool their resources to home in on fraud, waste, and abuse within health care organizations that frequently bill for services to the Centers for Medicare & Medicaid Services (CMS) or other federal benefits providers.
Since launching in 2007, the Medicare Fraud Strike Force has single-handedly sent the national rate of health care civil enforcements, criminal arrests, prosecutions, and convictions skyrocketing ? and it grows bigger nearly every year.
The Strike Force has declared mobile lab fraud to be among its top investigatory priorities. For that reason, anyone working in the home-health laboratory, diagnostics, or toxicology industry should maintain a high level of vigilance at all times. Thorough recordkeeping and careful compliance with CMS policy are essential.
Given the high costs associated with a fraud allegation (not to mention the potential criminal penalties), owners and executives in the home health industries are advised to consult with a mobile lab fraud defense attorney for compliance advice and ongoing preventative strategies.
While the Strike Force has a national purview and can seek enforcement anywhere in the United States, it is principally focused on the nine cities where it maintains an office (and their surrounding metros):
- Baton Rouge
- Brooklyn (NYC)
- Los Angeles
Why Is the DOJ so Focused on Mobile Laboratories and Diagnostics Providers?
A few bad people can give an entire industry a bad name. There have been several isolated, high-profile cases in which mobile lab and diagnostic corporations were involved in deliberate and extensive schemes to defraud the government and various insurers.
These instances are not reflective of mobile labs as a whole, of course, but they have nevertheless led the government to sound an alarm that effectively subjects all mobile providers to increased scrutiny.
Unfortunately, the real reason for the government’s interest in mobile lab fraud might simply be its record of success in that area. Federal investigators have managed to recover many millions of dollars from mobile health providers in recent years, and they have landed several high-profile criminal convictions along the way.
In many of these cases, the providers’ only real error was poor recordkeeping – a flaw the government pounced upon and distorted as evidence of so-called fraud. It can happen to anyone.
What Other Agencies Are Involved in Investigating Mobile Lab Fraud?
Federal agencies do not always work alone. For that matter, fraud investigations do not have to be exclusively federal. Law enforcement agencies routinely work together, freely sharing resources, data, and leads. Agencies involved in mobile lab fraud cases tend to include:
- Department of Justice (DOJ)
- Office of Inspector General (OIG)
- Department of Health and Human Services (HHS)
- Federal Bureau of Investigation (FBI)
- Private CMS contractors (e.g. RAC, MAC, ZIPC, etc.)
- Drug Enforcement Agency (DEA)
- State and local police
Which Types of Medical Labs Are Most Frequently Investigated?
- Mobile phlebotomy units
- On-site blood draw & blood testing centers
- Mobile radiology groups
- Mobile testing and imaging services
- Mobile toxicology labs
- Mobile diagnostic services for acute, long-term, or terminal patients
Talk to an Experienced Mobile Lab Fraud Defense Attorney Today
Whether the federal government is already questioning your billing history or you simply want to avoid that prospect for the future, the experienced mobile lab fraud defense lawyers at Oberheiden, P.C. can help. We have years of experience in health care fraud defense and a long record of success. Please contact us right away.
Compliance – Litigation – Defense
This information has been prepared for informational purposes only and does not constitute legal advice. This information may constitute attorney advertising in some jurisdictions. Reading of this information does not create an attorney-client relationship. Prior results cannot guarantee a similar future outcome in your case. Oberheiden, P.C. is a Texas firm with headquarters in Dallas. Mr. Oberheiden limits his practice to federal law.
Dr. Nick Oberheiden has successfully represented healthcare executives and physicians – as well as businesses in the areas of toxicology, pharmacy, home health and hospice centers, DME, hospitals, surgery centers, neuro-monitoring, and blood and DNA testing centers – in healthcare compliance and defense.