Home 5 Articles 5 Hospital Accused of Falsely Billing Lab Tests Agrees to $375,000 Settlement

Hospital Accused of Falsely Billing Lab Tests Agrees to $375,000 Settlement

by | Jan 26, 2022

Case: An Ohio hospital and the doctor who owns it have agreed to shell out $374,780 to settle charges of submitting false claims for prolactin and ammonia lab tests. Prolactin testing, which measures the level of prolactin in a person’s blood, is used to diagnose pituitary tumors or determine causes for conditions unrelated to psychosis […]

Case: An Ohio hospital and the doctor who owns it have agreed to shell out $374,780 to settle charges of submitting false claims for prolactin and ammonia lab tests. Prolactin testing, which measures the level of prolactin in a person’s blood, is used to diagnose pituitary tumors or determine causes for conditions unrelated to psychosis or substance abuse. Ammonia testing is used to diagnose liver dysfunctions or hyperammonemia. Significance: While Medicare and Medicaid cover prolactin and ammonia lab testing, the hospital allegedly violated coverage rules in three different ways:
  • The tests were performed on inpatients and thus part of the bundled DRG inpatient admission reimbursement and couldn’t be billed separately;
  • Test results weren’t used to manage the patients’ condition; and
  • The tests were medically unnecessary.

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