UC SAN DIEGO HEALTH PAID $2.98M TO SETTLE

U.S. claims one of its providers billed Medicare for unnecessary testing

UC San Diego Health has paid $2.98 million to settle claims that it ordered medically unnecessary genetic testing from a troubled company that was reimbursed by Medicare, the Justice Department said Tuesday.

Federal investigators alleged that UC San Diego Health doctors ordered and submitted referrals for genetic testing performed by three CQuentia labs that was not medically necessary, leading to false claims for payment to Medicare. By doing so, investigators allege the health system violated the False Claims Act, a workhorse statute in health care fraud cases that prohibits providers from billing the government for work not performed or not needed.

The false claims were submitted from December 2015 to October 2019 to CQuentia Arkansas Labs, CQuentia NGS and Total Diagnostic II, which is also a CQuentia business, according to the allegations.

It was unclear if a civil case had been filed against UC San Diego

Health. The DOJ did not release any additional details about the allegations, including why the tests were allegedly ordered, for how many patients, or by whom. The settlement was signed by the parties at the end of November, according to the settlement document.

UC San Diego Health did not admit any liability as part of the settlement, which allowed the provider to continue to focus on patient care, said UC San Diego Health spokesperson Jacqueline Carr.

“Working at the forefront of patient care sometimes involves the use of new technologies from emerging companies. When UC San

Diego Health learned that the Department of Justice had concerns about one of our technology providers, we fully cooperated and promptly resolved the matter,” Carr said in a statement. “The DOJ’s settlement announcement alleges that our doctors ordered tests from a company that then allegedly made false claims about those orders.”

“UC San Diego Health remains committed to integrating the leading best practices and technology into our research, teaching and patient care missions, in accordance with the highest standards of ethical conduct and all applicable laws and regulations,” Carr added.