Federal healthcare fraud enforcement is focusing on laboratory referral practices and medical necessity standards in pathology testing. Advanced Pathology Solutions, its management services organization and current and former owners agree to pay $30 million to resolve U.S. allegations tied to kickbacks and unnecessary testing.

Highlights

• Advanced Pathology Solutions agreed to a $30 million False Claims Act settlement with the DOJ over allegations of kickbacks and unnecessary pathology testing from 2015 to July 2022.
• The United States alleged APS provided unlawful kickbacks to gastroenterology practices and managed 'lean labs,' facilitating false claims to federal healthcare programs.
• The DOJ emphasized ongoing enforcement against healthcare fraud, highlighting scrutiny of laboratory billing and warning of consequences for improper referral and reimbursement practices.

Settlement covers kickback and testing allegations

As announced by the U.S. Department of Justice, the settlement resolves allegations in a complaint the United States filed on April 8 in the U.S. District Court for the Eastern District of Arkansas. The government alleges that Advanced Pathology Solutions PLLC, formerly known as Advanced Pathology Solutions LLC, and APS MSO LLC, together with current and former owners Kevin Hannah, Donell Burkett and Daniel Hunter Pledger, furnished unlawful kickbacks and ordered medically unnecessary pathology testing services.

The United States alleges that from 2015...

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