The labs were accused of using their own manipulated diagnosis codes in lieu of codes furnished by their patients' physicians to bill Medicare and Medicaid.
//According to the settlement agreement, Vista Clinical Diagnostics, along with Access Dermpath and Advanced Clinical Laboratories, billed Medicare and Medicaid for clinical laboratory services using diagnosis codes that were generated by a macro and inserted into beneficiaries’ reimbursement submissions. This allegedly occurred during the period from January 1, 2017, through December 31, 2021. According to the allegations, these diagnosis codes were generated by the Defendants and not provided by the beneficiaries’ physicians.//
The whistleblower who brought the case will recover over $440K.
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