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Urgent Care Clinic to Pay $2.8M to Resolve Claims of Overbilling for Diagnostic Tests

United States Attorney Pete Serrano announced that Health First Urgent Care, an urgent care clinic with locations in Richland and Pasco, Washington, has agreed to pay $2,807,729 to resolve claims that it fraudulently overbilled Medicare and Medicaid for diagnostic tests. According to the settlement agreement, a False Claims Act (FCA) claim arose from allegations that Health First Urgent Care fraudulently billed for polymerase chain reaction (PCR) respiratory and urinary tract infection panel testing. These panel tests were a predetermined group of medical tests used to test for multiple pathogens from a single sample obtained from a patient. The United States and State of Washington alleged that instead of billing for a single panel test, Health First Urgent Care improperly “unbundled” the panel test and billed for each individual test comprising the panel. This resulted in overbilling to Medicare and Medicaid programs. In addition, the State of Washington alleged that Health First Urgent Care improperly billed for panel tests that were more expensive and not medically necessary for individual patients, such as patients presenting with symptoms of Covid-19.