A recent whistleblower lawsuit filed against Genova Diagnostics in Asheville, N.C., accused the medical testing laboratory of committing Medicare fraud by ordering unnecessary tests for many of the lab’s patients.

Whistleblower Complaint Leads to Multi-Million Medicare Fraud Settlement

The Asheville Citizen Times reported that Darryl L., Genova Diagnostics’ former vice president and chief medical officer, was identified by the Department of Justice as the whistleblower who brought the allegations against the testing laboratory. As a result of his claims that the lab submitted unnecessary fecal tests and billed Medicare, TRICARE, and the federal employee health program, Genova Diagnostics has agreed to pay between $17 million and 43 million to settle the case.

According to Darryl’s whistleblower lawsuit, the laboratory violated the False Claims Act and defrauded government health programs by routinely ordering three tests that were not medically necessary for patients. These tests include the NutrEval and GI Effects Lab Test, which analyze stool samples, as well as the IgG allergen, which tests for food sensitivity.

In addition to ordering unnecessary tests, the lawsuit also claims that the company engaged in improper billing practices and referred patients to phlebotomy vendors with financial ties to the lab.

Although Genova Diagnostics claims that a thorough review of the company’s practices resulted in its own determination that the company did not engage in any fraudulent practices, the lab has agreed to pay millions to settle the case. Approximately $17 million will be paid through the surrender of claim funds held by Medicare and TRICARE, meaning that the government programs will not reimburse the lab for $17 million worth of services. Another $26 million may be paid out by the company over the next five years if agreed upon financial contingencies occur. Additionally, the company has agreed to establish and maintain a compliance program to prevent similar fraud from occurring in the future.

About Whistleblower Lawsuits

Darryl filed his whistleblower lawsuit against Genova Diagnostics under the False Claims Act, which allows individuals to file lawsuits on behalf of the government if they have evidence that fraud is being committed. The False Claims Act allows for qui tam lawsuits, or also known as whistleblower lawsuits, to encourage people with evidence of fraud against the government to come forward. Under the False Claims Act, people who file whistleblower lawsuits may be compensated between 15 percent and 25 percent of any financial damages recovered. Whistleblowers also have legal rights and protections to prevent employers from punishing them for speaking up.

Whistleblower lawsuits are often filed by employees or former employees against their employers. This is because in order to file a whistleblower lawsuit, you must have direct access to evidence showing that fraud is occurring. Although there are many types of whistleblower lawsuits, many of these cases involve Medicare fraud or fraud against other government health programs. This fraud is often committed by running unnecessary and expensive tests on patients, billing Medicare for tests that were never run, or offering incentives to physicians who refer patients to certain medical centers.

If you have evidence that your current or former employer has engaged in fraudulent activity against the government, you may be eligible to speak to a qualified attorney about filing a lawsuit. There are whistleblower laws in place that prohibit employers from retaliating against employees who speak out about fraud in the form of being terminated, demoted, harassed, threatened, denied benefits, or passed over for a promotion. making threats against them, refusing to promote them, or denying them benefits. Employees who file successful whistleblower lawsuits may be entitled to a percentage of any recovered compensation.

This article is not legal advice. It is presented
for informational purposes only.