On January 17, the United States Department of Justice (DOJ) announced a settlement of $704,249 between BioReference Health LLC, OPKO Health, Inc. (BioReference’s parent company,) and the United States, to resolve allegations of billing the government for unnecessary blood tests. The whistleblower who initiated the claim will receive $112,694 of that amount. The settlement, involving the nation’s third-largest clinical provider of laboratory tests and equipment, “demonstrates [the government’s] commitment to protecting the integrity of federal health care programs[,]” according to the head of the DOJ’s Civil Division, Principal Deputy Assistant Attorney General Brian M. Boynton.
The whistleblower and the United States allege that, from 2012 to 2023, BioReference performed more expensive blood tests than medical providers ordered for their patients. As a result, BioReference and OPKO Health billed federal healthcare programs, including Medicare, for these medically unnecessary tests, which the United States charged as fraud that violated the False Claims Act (FCA).
Specifically, medical providers allegedly ordered Complete Blood Count lab tests (CBC) without an automated white blood cell differential (WBC) for their patients. Tests with WBC are more complex and expensive than a typical CBC blood test without WBC. However, BioReference allegedly performed tests with WBC consistently without request and fraudulently billed federal healthcare programs for over a decade.
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