A San Diego laboratory has agreed to pay $2 million to resolve allegations that it caused the submission of false claims to Medicare for Breast Cancer Index tests that were not reasonable and necessary for the diagnosis and treatment of breast cancer, the Department of Justice announced Thursday.
By statute, Medicare can only pay for lab tests that are reasonable and necessary for the diagnosis or treatment of a patient’s illness or injury.
The United States alleged that Biotheranostics Inc. — a diagnostic laboratory testing company — knowingly promoted and performed the Breast Cancer Index test for breast cancer patients who had not been in remission for five years and who had not been taking tamoxifen, and thus for whom the test was not reasonable and necessary based on published clinical trial data and clinical practice guidelines.
“Fighting health care fraud will continue to be a priority of this office,” said U.S. Attorney Adam Braverman for the Southern District of California, which includes San Diego. “As this settlement demonstrates, we will vigorously investigate and hold responsible laboratories and other providers that choose to submit claims to federal health care programs for unauthorized or unnecessary services.”
The investigation was a coordinated effort by the Civil Division of the Department of Justice, the U.S. Attorney’s Office for the Southern District of California and the Department of Health and Human Services Office of Inspector General.
–City News Service
