Health First Urgent Care, which operates clinics in Richland and Pasco, Washington, has agreed to pay $2.8 million to settle allegations of overbilling Medicare and Medicaid for diagnostic tests. The announcement was made by United States Attorney Pete Serrano.
The settlement addresses claims that Health First Urgent Care improperly billed for polymerase chain reaction (PCR) respiratory and urinary tract infection panel testing. These panels are designed to test for multiple pathogens using a single patient sample.
Authorities from the United States and the State of Washington alleged that Health First Urgent Care “unbundled” these panel tests, billing separately for each individual test within the panel instead of charging for a single comprehensive test. This practice led to higher charges submitted to federal healthcare programs. Additionally, state officials claimed that the clinic billed for more expensive panel tests than were medically necessary in certain cases, including patients with symptoms related to Covid-19.
“Ensuring that healthcare providers comply with the requirements of Medicare and Medicaid not only maintains the integrity of these programs, but it also safeguards patients and results in better healthcare outcomes,” said Mr. Serrano. “I would like to express our appreciation for our collaboration with the Washington Medicaid Fraud Control Division and the exception investigative work performed by HHS-OIG. We will continue to ensure that fraud, waste, and abuse does not permeate federal healthcare programs.”
The investigation leading up to this settlement was conducted jointly by the United States Attorney’s Office, the Washington State Attorney General’s Office, and the Health and Human Services Office of Inspector General.
“Medicare and Medicaid exist to make sure families’ critical medical needs are met. It is vital that we protect the integrity of these programs,” said Washington State Attorney General Nick Brown. “This settlement will help ensure these funds are put to use as intended for Washingtonians.”
“It is critical for providers to bill Medicare, Medicaid, and other taxpayer-funded health care programs lawfully and accurately. The submission of false laboratory testing claims diverts key resources away from those who rely on them, including the elderly and low-income families,” said Jeffrey C. McIntosh, Acting Special Agent in Charge with the U.S. Department of Health and Human Services, Office of Inspector General (HHS-OIG). “HHS-OIG remains committed to working with our law enforcement partners to safeguard federal health care programs for the benefit of the American people.”
The case was handled by Assistant United States Attorney Jacob E. Brooks from the U.S. Attorney’s Office and Assistant Attorney General Rachel Sterett from the Washington State Attorney General’s Office.
