Patients Choice Laboratories (PCL), a diagnostic laboratory headquartered in Indianapolis, Indiana, agreed to pay the United States $9,620,000 to resolve allegations that it violated the False Claims Act and the Anti-Kickback Statute (AKS). The government alleges that PCL knowingly submitted claims to Medicare for respiratory pathogen panels (RPPs) that were either medically unnecessary or obtained through kickbacks. PCL also paid commissions to independent sales representatives and marketing firms (1099 representatives) based on the volume or value of referrals. Specifically, the United States alleges that on November 20, 2020, PCL entered into a Marketing Services Agreement (MSA) with a purported infection prevention company (the Company). Through the MSA, PCL agreed to pay $5,000 per month in exchange for “marketing and management services” in long-term care facilities. In reality, according to the United States, the MSA served as a pretext for paying the company for laboratory test referrals, which PCL then billed to Medicare.
Additionally, the United States alleges that PCL paid the Company to perform services in long-term care facilities, including specimen collection for infectious disease testing. The Company swabbed residents for COVID-19, and PCL used the same specimens to conduct and bill Medicare for medically unnecessary RPPs. In some cases, PCL billed for RPPs without performing any COVID-19 tests at all. Between December 1, 2020, and May 11, 2022, PCL paid the company approximately $1.86 million in exchange for RPP referrals. During this time, PCL billed Medicare for thousands of RPPs conducted at 43 long-term care facilities nationwide, receiving more than $6 million in reimbursement.