California Attorney General Kamala D. Harris recently announced a $241 million settlement—the largest recovery in the history of California’s False Claims Act—with Quest Diagnostics, the state’s biggest provider of medical laboratory testing, of a lawsuit alleging illegal overcharges to the state’s medical program for the poor.
"In a time of shrinking budgets, this historic settlement affirms that Medi-Cal exists to help the state’s neediest families rather than to illicitly line private pockets," said Harris. "Medi-Cal providers and others who try to cheat the state through false claims and illegal kickbacks should know that my office is watching and will prosecute."
The settlement with Quest is the result of a lawsuit filed under court seal in 2005 by a whistleblower and referred to the Attorney General’s office. The lawsuit alleged that Quest systematically overcharged the state’s Medi-Cal program for more than 15 years and gave illegal kickbacks in the form of discounted or free testing to doctors, hospitals, and clinics that referred Medi-Cal patients and other business to the labs.
California law states that, "no provider shall charge [Medi-Cal] for any service more than would have been charged for the same service to other purchasers of comparable services under comparable circumstance." Yet, Quest charged Medi-Cal up to six times as much as it charged some other customers for the same tests.
California law also prohibits Medi-Cal providers from soliciting and receiving "any kickback, bribe, or rebate, directly or indirectly, overtly or covertly, in cash or in valuable consideration of any kind [in] return for the referral, or promised referral, of any individual for the furnishing of any service" paid for by Medi-Cal.
According to the attorney general’s complaint, Quest systematically offered doctors, hospitals and clinics low prices for lab tests in return for referrals to Quest of patients, including Medi-Cal patients. Quest then allegedly charged Medi-Cal a higher price to make up the difference—resulting in the loss of millions of dollars to the Medi-Cal program.
The Attorney General’s Bureau of Medi-Cal Fraud and Elder Abuse conducted an intensive three-year investigation that uncovered widespread abuse of Medi-Cal by medical testing laboratories in California.
Based on allegations in the complaints, the California Department of Health Care Services, which administers the Medi-Cal program, launched an independent statewide audit of medical laboratories. Through reform of industry pricing practices stemming from this case, Medi-Cal is expected to save hundreds of millions of dollars.
"This agreement sends a strong message that fraud against the state and its Medi-Cal program will not be tolerated," said Toby Douglas, director of the Department of Health Care Services. "I commend our department’s employees and the Department of Justice for working successfully in pursuit of compensation and justice for the state and its important health care programs."
Besides providing compensation to the whistleblower under statutory guidelines, the settlement is designed to reimburse the state’s Medi-Cal program and the Attorney General for expenses in investigating and prosecuting false claims actions. The total that will flow to the state is $171 million.
The settlement also requires Quest to report information to assist the state in determining Quest’s future compliance with Medi-Cal’s pricing rules.
A copy of the original complaint can be found here.
