On January 17, the Department of Justice announced that BioReference Health LLC, formerly known as BioReference Laboratories Inc., and its parent company, OPKO Health Inc., agreed to pay $704,349 to resolve allegations brought under the False Claims Act. The government alleged that BioReference and OPKO improperly billed federal healthcare programs for more expensive blood tests than those ordered by healthcare providers.
The allegations focused on the billing practices for complete blood count (CBC) tests. According to the government, between January 1, 2012, and March 1, 2023, healthcare providers typically ordered standard CBC tests without white blood cell (WBC) differentials. However, the government claims that BioReference and OPKO conducted CBC tests with WBC differentials, which are more detailed and costly, and billed federal healthcare programs for these tests. The government further alleges that these additional analyses were not requested by providers and may not have been medically necessary, potentially increasing costs to federal programs.
The settlement resolves these allegations without any admission of liability or determination of wrongdoing. BioReference and OPKO cooperated fully with the investigation and the settlement process. The claims were initially raised in a whistleblower lawsuit filed under the False Claims Act’s qui tam provisions, which allow private individuals to bring claims on behalf of the government and receive a share of any recovery. In this case, the whistleblower will receive $112,694 from the settlement amount.
Federal officials emphasized their commitment to prosecuting these matters. “My office remains committed to addressing practices that can drive up healthcare costs unnecessarily and waste taxpayer dollars.” Maureen R. Dixon, Special Agent in Charge of HHS-OIG, noted, “Laboratory companies have a responsibility to ensure that the tests performed align with the orders of physicians.”
If you or your business is addressing similar compliance concerns or allegations related to healthcare billing practices, Chilivis Grubman’s experienced attorneys are here to help. Contact us today to learn how we can assist in navigating these complex legal matters.