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Medicus Laboratories Agreed to Pay $5 Million for Allegedly Violating the Civil Monetary Penalties Law by Submitting Claims for Excessive Units of Urine Drug Testing and Medically Unnecessary Screening Tests

Medicus Laboratories, LLC (Medicus), Texas, agreed to pay $5,000,000 for allegedly violating the Civil Monetary Penalties Law. OIG contends that Medicus submitted false or fraudulent claims to Medicare as follows: 1) by inappropriately using Modifier 59 to submit claims for payment for multiple units of HCPCS code G0431 when only a single unit may be billed per patient encounter; and 2) by inappropriately submitting claims for HCPCs codes 83986 (pH of body fluid), 82570 (creatinine, other sources), 81005 (urinalysis, qualitative or semi-quantitative, except immunoassays), and 81003 (urinalysis, by dip stick or table reagent) when the testing was for screening purposes and was not medically reasonable and necessary.

Action Details

  • Date:February 14, 2014
  • Enforcement Types:
    • CMP and Affirmative Exclusions