Author Topic: Horizon Blue Cross Blue Shield v. Avee, et. al. including Does and ABC Corps  (Read 8027 times)

Offline ethercat

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This post came out of discussion in the QUEST DIAGNOSTICS SEEKS TO GARNISH THOUSANDS FROM CENTER'S BANK ACCOUNTS thread.  I thought it deserved its own, and it does get into subjects that are similar to Narconon's drug testing operations.

The lawsuit is:
Horizon Blue Cross Blue Shield of New Jersey v. Avee Laboratories; Alere, Inc., Alere Toxicology Services, Inc.; Laurie Deerfield, D,O.; Leading Edge Recovery Center, LLC; John Does 1-10; and ABC Corporations 1-10.

I don't know if Narconon is involved in this case as one of the John Does or ABC Corporations, or even at all.  Perhaps someone who does know will come forth, and hopefully will be able to explain how they know.

Here are some posts from the thread that spawned this monster post:
Actually, rehabs can charge the insurance for drug testing and use an outside agency and pocket the difference. 

For example, there are a lot of fraud cases going on, in which treatment centers/sober living houses were drug testing people daily and then billing insurance for it. 

http://treatmentmagazine.com/newswires/428-horizon-blue-cross-nj-alleges-huge-drug-testing-fraud-.html

I should have explained myself better. I'm well aware that drug tests are a must. Some rehabs are making a fortune off labs. The ethical ones are having reasonably priced ones done in the $60.00 range. Others are profiting from labs and source's link is a good example. They are billing $1200.00 for these labs! Outrageous!

http://pathologyblawg.com/pathology-news/pathology-law/healthcare-fraud-pathology/horizon-bcbs-sues-avee-laboratories-others-urine-drug-testing-fraud/


I am well aware of the racket...however in this case the company does the billing not narconon so narconon does not profit.  My point was that yes narconon does many sketch things but this is not one of them.

Well, they owe the money for something :) Could be insurance claim related. Claims billed by NN instead of directly by the lab? All the Narconons are being looked into for insurance fraud.

This article explains some of how the game works:
Kickbacks and Other Abuses “Rampant” in Drug Testing Industry-American News Report

Kickbacks, which employees wouldn't necessarily know about, go to the owners or directors for using the lab.  Providers can bill for the purchase of the kits and administering the test, then they can send it off to the lab for "confirmation" of results, and now the lab gets to bill too.  Lots of insurance money to go around, at least until the insurance companies catch on.  In the meantime, it costs us all in higher rates to make up for it.  And then there was the "double dipping" that Narconon of Georgia was doing, at least in one case, billing the client AND the insurance.

I'm not saying this is what Narconon was or is doing, because I don't know, but it's food for thought. 

(Hopefully, not to give Narconon any ideas.   ooo:/ )

The Horizon Blue Cross Blue Shield vs. Avee Laboratories et.al lawsuit complaint also spells out how Health Care Providers got insurance payments, as well as the labs involved.  The complaint is here:
http://pathologyblawg.com/wp-content/uploads/2013/10/BCBS-v.-Avee.pdf

And also here: http://alley.ethercat.com/storage/2013-08-23-HorizonBlueCrossBlueShield-v-Avee.pdf

Quote from: Pages 2 and 3; paragraphs 2 - 6
2.  Physicians, substance abuse centers and other health care providers (collectively "Health Care Providers"), when appropriately authorized, may perform Point of Care Testing ("POCT") on urine samples at their offices and facilities to identify the presence of drugs and other substances in their patients' systems.  Health Care Providers perform POCT when it is medically necessary based on a patients' history and the results of prior testing.

3.  Clinical laboratories perform confirmatory tests on urine samples at the request of Health Care Providers.  A Health Care Provider may order confirmation of negative POCT results by a clinical laboratory only when the Health Care Provider has documented clinical reasons to believe the initial POCT is inaccurate or inconclusive.

4.  To generate unnecessary POCT and confirmatory tests, Defendant Avee Laboratories ("Avee") published false and deceptive marketing materials and offered unlawful inducements that encouraged Health Care Providers to perform medically unnecessary POCT and to refer their patients to Avee for unnecessary confirmatory testing.  Among other things, Defendant Avee falsely advised Health Care Providers that they could generate supplemental income by rendering and submitting claims to insurers like Horizon for performing POCT only when the provider also ordered confirmatory testing of the POCT results from a clinical laboratory, like Avee.

5.  As a result of this scheme, Health Care Providers, including Leading Edge Recovery Center and Laurie Deerfield, rendered unnecessary POCT.  Despite repeated negative results and the absense of any clinical reason to believe that the negative results were inaccurate, Health Care Providers requested Avee to perform unnecessary confirmatory tests ont he same urine samples.  Health Care Providers often used order forms known as Custom Test Panels provided by Avee to request confirmatory testing.  These Custom Test Panels, may of which were not signed by the ordering provider, allowed Health Care Providers simply to check a box directing Avee to provide numerous tests without regard to medical need or reason.

6.  To get paid for unnecessary tests, Health Care Providers submitted false claims to Horizon for medically unnecessary confirmatory tests.  As a result of this scheme, since 2009, Horizon faced an explosion in claims for unnecessary POCT (Point of Care Testing) and confirmatory tests.  In all, Horizon paid Health Care Providers approximately Twelve Million Dollars ($12,000,000.00) for unnecessary POCT and paid Avee in excess of Twenty-Four Million Dollars ($24,000,000.00) for unnecessary confirmatory tests.


So that's how the providers (Narconon is considered a provider, although they are not named in the Avee lawsuit) got insurance payments for testing, while the labs got paid for the confirmatory testing.  The confirmatory testing is only supposed to be done if there are "documented clinical reasons to believe the initial POCT is inaccurate or inconclusive."



Quote from: Page 4; Paragraph 10
10.  Defendant Avee Laboratories ("Avee") is a Florida corporation which operated a clinical laboratory to which Health Care Providers referred specimens for laboratory testing and services.  Avee was formed in 2008 and maintained its principal place of business at 14440 Myerlake Circle, Clearwater, Florida.

Quote from: Page 5; Paragraphs 18 and 19
18.  Defendants John Does 1-10 are other Health Care Providers, rehabilitation centers and individuals who accepted unlawful inducements from Defendants Avee, Alere and Alere Toxicology and participated in, and/or encouraged others to commit the fraudulent and wrongful acts set forth in this Complaint.

19.  Defendants ABC Corporations 1-10 are other Health Care Providers, corporations and entities, including rehabilitation centers, which accepted unlawful inducements from Defendants Avee, Alere and Alere Toxicology and participated in, and/or encouraged others to commit the fraudulent and wrongful acts set forth in this Complaint.


A couple of labs used by Narconon, as mentioned in the other thread referenced above:
Allegiance in Jackson, MS (Thanks lastvestige22!)
Medytox (Thanks FreeAtLast!)

Medytox is a conglomerate of related services, including a Medical Billing Service acquired by them, interestingly enough, called ARC Medical Billing, Inc. in Charlotte, NC.  ARC has at least 2 domains, both of which show the same content, arcmedicalbillinginc.com and arc-inc.org.

More about the CLIA waivers mentioned in the complaint:
http://www.fda.gov/medicaldevices/deviceregulationandguidance/ivdregulatoryassistance/ucm124202.htm
Quote
In November 1997, the CLIA waiver provisions were revised by Congress to make it clear that tests approved by the FDA for home use automatically qualify for CLIA waiver. Professional use versions of home use tests are not automatically waived. However, such professional versions do qualify for expedited waiver review since only the differences between the home use and professional use versions need to be examined to determine whether the professional version qualifies for waiver.

To summarize, under the current process, waiver may be granted to: 1) any test listed in the regulation, 2) any test system for which the manufacturer or producer applies for waiver if that test meets the statutory criteria and the manufacturer provides scientifically valid data verifying that the waiver criteria have been met, and 3) test systems cleared by the FDA for home use.

An example of CLIA Waived Tests:
http://drugtestingforless.com/category/CLIA.html

This may just be another long and winding rabbit hole with an exit 12 inches away from the entrance, but anyway, at least we have some info compiled in case it turns out to be more than that.
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Offline Mary_McConnell

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Thanks, ethercat.
I am a volunteer advocate for victims of the Narconon scam. I am a former scientologist. I post anonymously. Mary McConnell is my long time nom de plume. Feel free to contact me for assistance in righting the wrongs.

Offline mefree

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Case is moving slowly... Motion to dismiss denied. Discovery due February of 2015.

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Offline mefree

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This is still an active case. Several of the parties are showing dismissed.

002   AVEE LABORATORIES                     DF   DISM W/PRE   10  15  2014     
003   ALERE INC                             DF   DISM W/PRE   10  15  2014     
004   ALERE TOXICOLOGY SER  VICES INC       DF   DISM W/PRE   10  15  2014     
005   DEERFIELD, DO  LAURIE                 DF   DISM W/O P   04  25  2014
009   RICH,   JOHN T                        DF   DISM W/PRE   10  22  2014 

The following parties are still active in the case, including Blue Cross Horizon.

006   LEADING EDGE RECOVER  Y CENTER        DF   ACTIVE                         
007   JOHN DOES   1-10                      DF   ACTIVE                         
008   ABC CORPORATIONS      1-10            DF   ACTIVE     
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Offline mefree

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Now, Cigna files a similar suit. Urine drug screens must be a very profitable business!

Cigna accuses urine drug toxicology laboratories of fraud, kickback scheme - The Pathology Blawg
august 3, 2015
Quote
Health insurer Cigna recently filed a lawsuit against Sky Toxicology Lab Management and urine drug toxicology (UDT) laboratories Sky Toxicology, Frontier Toxicology and Hill Country Toxicology that, among other things, accuses them of engaging in fraud and a lucrative patient-referral kickback scheme.

All three labs are located in San Antonio Texas.  Sky Tox and Frontier Tox are about a block apart from one another, and Hill Country Tox is about a 10 minute drive away.  According to the “About Us” pages on the websites, the three UDT labs share the same executive team:  W. Wade White, MD-CEO and Medical Director; Lance Hupfeld-Chief Sales Officer; Bradley West-Chief Operating Officer.

Sky Toxicology Lab Management is a limited partnership organized in Florida in 2013, according to the Form D on file with the Securities and Exchange Commission.  Its principal place of business has the same address as Sky Toxicology, and it lists Dr. White, Mr. Hupfeld, Mr. West and a fourth individual named Nick Boatman as its executive officers.
More at http://pathologyblawg.com/pathology-news/pathology-law/healthcare-fraud-pathology/cigna-accuses-urine-drug-toxicology-laboratories-fraud-kickback-scheme/#more-14953

Lawsuit linked in article, and here: http://pathologyblawg.com/wp-content/uploads/2015/08/Cigna-v-Sky-Tox.pdf

Related article:
OIG: Not charging a patient for laboratory testing could violate Anti-Kickback Statute
« Last Edit: August 05, 2015, 22:04 by mefree »
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Offline mefree

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I hope this doesn't make heads spin. This is a related case I've been watching. I'm sure Millennium is ecstatic that the appeals court has vacated the judgment against them. That being said, the Feds may not be done with them yet.

Appeals court vacates judgment against Millennium Health in point-of-care urine cup case - The Pathology Blawg
Quote
The Eleventh Circuit Court of Appeals has vacated the judgment against Millennium Health (MH) in a lawsuit in which Ameritox accused it of violating the Stark Law and federal Anti-Kickback Statute (AKS) by providing free point-of-care urine drug testing (POCT) cups to physicians.

As the Eleventh Circuit said in its 45 page decision, this case was “extraordinarily complex”, and so I will only provide very broad strokes as to what has transpired over the four years since the case was filed.

Much more at http://pathologyblawg.com/pathology-news/pathology-companies/ameritox/appeals-court-vacates-judgment-millennium-health-point-care-urine-cup-case/
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Offline SocialTransparency

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What exactly are the issues here?

Offline mefree

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It's complicated. Basically Ameritox is alleging that Millennium is receiving remuneration through offering free Point of Care Testing (POCT) urine cups. Free sounds like no remuneration, right?

For their part, Millennium claims the providers agreed not to bill for for the POC tests, but.....
Quote
Ameritox claimed many physicians were in fact receiving a financial benefit from the free POCT cups.

Ameritox stated that instead of testing specimens one at a time while the patient was still in the office (POC testing), which reimbursed about $20 at the time, the physicians would instead batch test specimens from multiple patients all at once at the end of the day on in-office chemical analyzers before they shipped the urine to ML.

They would then bill payors for the chemical analysis, which at the time reimbursed $180 a pop.  Ameritox claims some physicians tested hundreds of specimens a month in this fashion.

More here: http://pathologyblawg.com/pathology-news/pathology-law/healthcare-fraud-pathology/millennium-laboratories-violated-stark-law-aks-free-urine-test-cups/
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Offline mefree

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This article mentions the pee scams and unfortunately the death of another young girl.

Pee Scams, Kickbacks, And Overdoses Plague South Florida Rehabs - BuzzFeed
Quote
When Nicole Cronin’s parents sent their daughter from suburban New Jersey off to a Florida rehab to treat her opiate addiction, they hoped it would help free her from the relapses they’d watched her cycle through at home.

Instead, she ended up dead at 20 years old. Her body was found in a cheap motel a few miles from the $800-a-month halfway house her parents were footing the bill for, according to a lawsuit filed by her family.

Nicole died in Delray Beach, the “recovery capital of America.” The oceanfront vacation spot is home to thousands seeking sobriety — as well as scam artists who prey on addicts and their insurance plans.
more at http://www.buzzfeed.com/catferguson/the-rehab-scam

 
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Offline BigBeard

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One of the links in the Buzz Feed story leads to this HuffPost Politics story from back in August:

http://www.huffingtonpost.com/entry/heroin-addiction-treatment_55cd1855e4b055a6daafe67f

narCONon, and their shills, are going to like the Feds pushing medically based treatment one little, tiny, bit.
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Offline mefree

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Offline ethercat

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Here's more about this scam:

Cigna pulls out of Fla. exchange, blames addiction treatment fraud

Quote
Citing “an exponential increase in fraudulent and abusive” substance abuse treatment practices — and in particular drug screening — Cigna Inc. won’t be offering Florida health plans on the federal Health Insurance Marketplace when it opens for business Nov. 1.

In explaining the decision, Cigna spokesman Joseph Mondy singled out stories in The Palm Beach Post detailing how fraudulent drug screening has reaped millions for South Florida labs, especially those affiliated with sober homes and treatment centers. In one case revealed by The Post, pee-in-a-cup lab work cost more than $300,000 for a single client.

...

The billing that is believed to have attracted the attention of the FBI, however, is a simple urine test to check for the presence of drugs. It’s a staple of rehab and a fast way to track relapse.

However, some treatment centers, sober homes and their affiliated labs have charged hundreds of dollars for the test.

Then, the same urine sample would be shipped off to another lab for more extensive testing, which could cost $3,500 or more.

An addict tested three times a week with the more sophisticated urinalysis is a cash machine: $36,000 every month, $432,000 a year. A sober home with six residents on the same testing regimen could bring in $2.5 million.

Much more in the linked article.
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Offline mefree

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Quote
No good deed

If Cigna is hard-hit, said Delray Beach attorney Jeffrey Lynne, it’s largely because Cigna offered a Florida plan on the exchange with the best benefits for substance abuse treatment.

“I guess no good deed goes unpunished,” said Lynne, who represents treatment centers and has worked with lawmakers to rein in abuses.

Lynne said he believes the fraudulent charges gave Cigna an excuse to do something it wanted to do anyway: Exit behavioral health coverage and protect its bottom line as a pending $54 billion merger with Anthem is finalized.

“It’s easy to villainize the industry,” Lynne said.

But Lynne conceded that the largely unregulated South Florida treatment industry has led to a wide range of abuses.

In one scam, for instance, brokers would go out of state to find addicts in need of assistance and arrange to bring them to Florida, sources told The Post. Claiming they were “residents,” they purchased a Florida policy on the exchange.

That's a pretty balanced take on the situation and quite unfortunate for Florida residents who get their benefits on the public exchange.
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Offline mefree

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Here's how things ended with the DOJ for Millenium.

Millennium Health Ends DOJ Probe, Said to Prepare for Ch. 11 - Bloomberg Business
Quote
Millennium Health LLC agreed to pay $256 million to resolve claims that it misrepresented the need for procedures and offered gifts to doctors in exchange for referrals.

The biggest U.S. lab-testing company now plans to file for bankruptcy protection by Nov. 10, enabling it to turn over control of the business to its lenders, according to a person with knowledge of the matter.

more at http://www.bloomberg.com/news/articles/2015-10-19/millennium-health-agrees-to-pay-256-million-to-settle-doj-probe
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Offline Mary_McConnell

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Thanks for keeping us abreast of all this, mefree.

Maybe FL will finally do something to plug all the loopholes that have allowed these scams to grow.
I am a volunteer advocate for victims of the Narconon scam. I am a former scientologist. I post anonymously. Mary McConnell is my long time nom de plume. Feel free to contact me for assistance in righting the wrongs.

Offline mefree

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Thanks for keeping us abreast of all this, mefree.

Maybe FL will finally do something to plug all the loopholes that have allowed these scams to grow.

Let's hope. Florida is risky business. No pun intended!
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Offline mefree

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The Oklahoma AG seems to be taking an interest in urine testing scams.

Urine testing labs draw scrutiny of Oklahoma attorney general’s office - NewsOK

Quote
The Oklahoma attorney general's office is investigating a group of laboratories involved in the state's booming urine testing industry, The Oklahoman has learned.

While the investigation has yet to be officially confirmed, documents obtained through an open records request show the agency's Medicaid Fraud Control Unit is looking into some urine testing laboratories doing millions of dollars in business with Oklahoma health care providers.

Will Gattenby, attorney general spokesman, said the agency can't share much information because of “the sensitive nature of the investigation.”

more at http://newsok.com/article/5508856
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Offline mefree

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Alere acquired Avee prior to this recent news.

Alere Faces Criminal Probe Over Medicare, Medicaid Billing - Wall Street Journal
Deal for Abbott Laboratories to buy Alere for nearly $5 billion has yet to close
By LIZ HOFFMAN,  ARUNA VISWANATHA and  JONATHAN D. ROCKOFF
Updated July 27, 2016 8:20 p.m. ET
Quote
Federal investigators are seeking information about government-billing practices at Alere Inc., adding to a litany of woes at the diagnostic-testing company as it seeks to complete a deal to sell itself.

The Justice Department’s criminal-fraud section sent Alere a subpoena recently seeking patient-billing records, according to people familiar with the matter. It asked for information about Alere’s efforts to collect copayments from patients, as well as forms submitted on their behalf to government programs such as Medicare, the people said.

more at http://www.wsj.com/articles/alere-faces-criminal-probe-over-medicare-medicaid-billing-1469649920
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Offline mefree

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For those who have been following this thread, Alere's merger plans with Abbott may be in jeopardy. Tmk, the federal probe over potential Medicare/Medicaid billing fraud is still ongoing, and sales practices are under investigation related to FCPA. I don't blame Abbott for taking a second look at this deal, but Alere will sue.

Mediation Talks Between Abbott and Alere Collapse - TheStreet
Sept 28, 2016
Quote
Mediation efforts between Abbott Laboratories (ABT) and Alere (ALR) have broken down, Alere said in a Sept. 26 SEC filing. With the failure of the talks, Alere will likely proceed with a lawsuit in the Delaware Court of Chancery where it it trying to force Abbott to complete its $5.6 billion purchase of Alere. The Waltham, Mass.-based provider of point-of-care testing sued Abbott last month, claiming that the Abbott Park, Ill.-based medical device and diagnostics company has delayed in obtaining antitrust approval for the deal in an effort to kill the transaction, which has an April 30 drop-dead date. Neither company immediately returned a request for comment.

Abbott agreed to pay $56.00 a share for Alere on Feb. 1, a 49% premium, but the deal soon ran into trouble. On March 15, Alere stock fell by 8% when it announced that it had received a U.S. Department of Justice subpoena about the company's sales practices in Africa, Asia and Latin America, which may have raised issues under the Foreign Corrupt Practices Act. And on April 20, Abbott CEO Miles White was equivocal about his commitment to the Alere deal in an earnings call where he noted that Alere was delayed in filing its annual report with the SEC. (Alere finally filed its annual report on Aug. 8.)

more at https://www.thestreet.com/story/13755232/1/mediation-talks-between-abbott-and-alere-collapse.html
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Offline Mary_McConnell

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Thanks, mefree.

After Millennial and Avee, it still doesn't look like US Department of Justice has had such an impact on pervasive lab scams... apparently its an industry rife with money making opportunities and little regulation

The Wild West Of New Laboratory Scams
July 11, 2016 by Larry Husten , Cardio Brief
http://cardiobrief.org/2016/07/11/the-wild-west-of-new-laboratory-scams/

Every time I see posts to this thread, I can't help but be reminded of MedPro Billing, Inc and Ms Melissa Z.
I have updates on her to post but first some pdfs to upload on Scribd, and link with them   \--O--/ 
http://forum.reachingforthetippingpoint.net/index.php/topic,12245.0.html
I am a volunteer advocate for victims of the Narconon scam. I am a former scientologist. I post anonymously. Mary McConnell is my long time nom de plume. Feel free to contact me for assistance in righting the wrongs.