July 30, 2020

Biotech Testing Company to Settle Fraudulent Billing and Kickback Claims for $49 Million

The DOJ issued a statement on July 23 that it, along with several other agencies, settled fraudulent billing and kickback claims against Progenity Inc., a biotech company that provides molecular and diagnostic tests. DOJ alleged that Progenity circumvented medical necessity criteria by billing under a CPT code that did not accurately describe the tests it provided, resulting in payment for non-reimbursable tests or substantially higher reimbursement than otherwise permitted. Furthermore, DOJ alleged illegal kickbacks from 2012 through 2018 by paying fees that exceeded fair market value to physicians to draw patient blood; providing food and alcohol to physicians and their staff with little or no educational content; and routinely reducing or waiving coinsurance and deductible payments without evaluating the patient’s financial need or making reasonable efforts to collect payment. Progenity agreed to pay approximately $49 million to settle these claims.