Singulex Inc. recently agreed to pay $1.25 million in a qui tam settlement over allegations that the company billed Medicare and TRICARE for unnecessary laboratory testing.

The company was accused of billing the government programs for unnecessary laboratory testing. False claims for money from government programs directly impact the millions of taxpayers in the United States.

This settlement payment will resolve these allegations that Singulex billed Medicare and TRICARE for unnecessary laboratory testing. The claims, initiated by whistleblowers, were investigated by different government officials including special agents working for Health and Human Services’ Office of the Inspector General.

This qui tam lawsuit was filed by whistleblowers Vicki S. and Jim V., who discovered the alleged false billing scheme. Whistleblowers are individuals who witness fraud against the federal government, and can file legal action on behalf of the government under the False Claims Act. Whistleblowers are one of the most important tools in preventing fraud against the federal government, which was the case with Vicki and Jim.

“This settlement reflects the continuing commitment of the U.S. Attorney’s Office and our law enforcement partners to identify and prosecute improper Medicare and TRICARE billings by companies that are looking to increase their profits at the expense of taxpayers and without regard to proper patient care,” said U.S. Attorney Alex G. Tse in a press release.

Overview of Healthcare Fraud Allegations

According to the qui tam lawsuit, Singulex had submitted false claims for unnecessary laboratory testing to Medicare and TRICARE by allegedly instructing healthcare providers to select specific diagnosis codes that maximized billing amounts. These codes were allegedly selected regardless of the patient’s medical condition, if they even needed medical testing, or without proper notification or consent.

Furthermore, the qui tam lawsuit alleges that Singulex deliberately pressured healthcare providers to order laboratory tests for patients regardless of the patient’s condition and misrepresented different facts to healthcare providers that prompted them to order more unnecessary laboratory testing.

The company also allegedly implemented procedure codes to laboratory test requisition forms without notifying healthcare providers, which caused Medicare, TRICARE, and other federal care programs to bear the brunt of the expensive healthcare bills.

“Health care companies that use illegal shortcuts to boost profits undermine the financial integrity of federal health care programs,” said HHS-OIG Special Agent in Charge Steven J. Ryan in a statement.

This kind of healthcare fraud is one of the most prominent forms of fraud the United States government faces, impacting millions of taxpayers. Federal and state healthcare programs are in place to help United States citizens who need financial assistance with their medical bills.

However, many healthcare companies have been found to have committed billing fraud against the company by sending bills for expensive and often unnecessary medical services. Common examples of healthcare fraud include, but are not limited to:

• Deliberately upcoding in medical bills
• Billing for expensive and unnecessary laboratory testing or healthcare services
• Healthcare providers and physicians having an illegal kickback arrangement
• Claiming and billing for medical services that were not provided by a medical professional

Whistleblowers may receive between 15 to 30 percent of recovered money when a qui tam lawsuit results in a settlement or judgment. Whistleblowers are often employees of healthcare companies who have direct knowledge about fraudulent activity and are in a position to report it to the federal government. Whistleblowers are also protected from retaliation against their employment under the False Claims Act.