Case: VerraLab JA, LLC, has agreed to pay $125,983 after self-disclosing that it billed Medicare for specimen validity tests (SVT) performed to authenticate urine samples for drug testing. Unlike the underlying urine drug test which is actually used to manage treatment, SVT is not considered medically necessary by Medicare where its sole purpose is to validate the specimen, i.e., verify that it hasn’t been adulterated.
Significance: In Feb. 2018, the OIG issued a report saying that Medicare made $66.3 million in improper SVT payments to nearly 4,500 labs and physician offices. CMS has ordered Medicare contractors to recover those payments. Meanwhile, labs are proactively coming forward to self-disclose. VerraLab is the fourth settlement involving SVT payments that OIG has reported in the first quarter of 2019. The other three also involve providers from the Ohio Valley area:
| Self-Disclosed SVT Payment Settlements (Jan. thru March 2019) | |||
|---|---|---|---|
| Date | Lab | Settlement Amount | |
| Jan. 24 | Northern Kentucky Center for Pain Relief | $126,799 | |
| Feb. 6 | Wheelersburg Internal Medicine Group + Mohammad Mouhib Kalo, MD (Ohio) | $111,706 | |
| March 13 | VerraLab JA, LLC (Louisville, KY) | $125,983 | |
| March 13 | Medical Specialist of Kentuckiana, PLLC (MSK) (Louisville, KY) | $69,776 | |
