California Genetic Testing Service Pays $11 Million To Resolve False Claims Allegations

[nitpicker]

https://www.justice.gov/usao-wdky/pr/california-genetic-testing-service-pays-11-million-resolve-false-claims-allegations

Department of Justice
U.S. Attorney’s Office
Western District of Kentucky

FOR IMMEDIATE RELEASE
Thursday, March 8, 2018

California Genetic Testing Service Pays $11 Million To Resolve False Claims Allegations

Allegedly submitted fraudulent medical claims for reimbursement

Will Pay $10,635,615.90 as part of Federal Settlement and $756,183 to a Number of States

LOUISVILLE, Ky. – United States Attorney Russell M. Coleman, acting on behalf of the Office of Inspector General of the Department of Health and Human Services, the TRICARE Program, and the Federal Employees Health Benefits Program (FEHB) today announced a $10,635,615.90 settlement with Natera, Inc., to resolve claims that Natera improperly billed federal healthcare programs for Natera’s non-invasive prenatal test known as Panorama®. Natera has also agreed to pay an additional $756,183 to a number of state Medicaid programs.
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The United States contended that between January 1, 2013, through December 31, 2016, Natera knowingly submitted false or fraudulent claims seeking payment from the TRICARE Program, FEHB, and Medicaid program for Natera’s genetic testing services, including its non-invasive prenatal test known as Panorama® (including optional panels that screened for microdeletion syndromes).

Specifically, the United States contended that for dates of service between January 1, 2013, through March 4, 2015, Natera improperly billed TRICARE for its Panorama® test, (including optional panels that screened for microdeletion syndromes), when TRICARE did not reimburse for certain laboratory developed test. Further, during dates of service between January 1, 2013, through December 31, 2016, Natera improperly billed TRICARE for non-invasive prenatal screening of certain microdeletion syndromes when TRICARE did not reimburse for this screening. During the same period, Natera improperly billed TRICARE, FEHBP, and Medicaid for its Panorama® test and for its non-invasive prenatal screening of certain microdeletion syndromes, by using an improper code which misrepresented the services Natera was billing to these programs. Lastly, during the same dates of service, Natera billed TRICARE, FEHBP, and Medicaid for its Panorama® test (including optional panels that screened for microdeletion syndromes) for patients with low-risk pregnancies. Natera denies this allegation.

This matter arose as a complaint for monetary damages under the qui tam provisions of the federal False Claims Act. The relators, Sallie McAdoo and Steven Aldridge, filed a qui tam action on January 26, 2015, in United States District Court for the Western District of Kentucky (United States, ex rel. Sallie McAdoo and Steven Aldridge v. Natera, Inc., Civil Action No. 3:15-cv-88-DJH).

Natera is entering into a separate settlement agreement in the amount of $756,183.00 (the “Medicaid State Settlement Agreements”) for similar conduct related to various state Medicaid programs. The Medicaid State Settlement Agreement was negotiated by a team with the National Association of Medicaid Fraud Control Units.
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