Skip to main content
Premium Trial:

Request an Annual Quote

Caris Pays $2.9M to Resolve Allegations of Medicare Billing Fraud

NEW YORK – Caris Life Science has agreed to pay about $2.9 million to resolve allegations that it violated the False Claims Act by improperly billing Medicare for its Caris Molecular Intelligence and ADAPT Biotargeting System tests, the US Department of Justice said Wednesday.

According to the DOJ, Irving, Texas-based Caris billed the federal government for cancer testing in violation of Medicare's so-called 14-Day Rule, which prohibits labs from separately billing Medicare for tests done if a physician orders the test within 14 days of the patient's outpatient or inpatient hospital stay.

DOJ alleges that Caris billed the Centers for Medicare and Medicaid Services (CMS) for testing when tests were ordered and submitted within 14 days after an inpatient discharge. In such cases, the tests would be covered by a lump-sum Diagnosis-Related Group payment from CMS to the hospital, meaning that Caris was trying to bill for tests that had already been reimbursed. According to the DOJ, the company also billed CMS directly for tests ordered within 14 days of patients' outpatients procedures. Additionally, the DOJ alleged that Caris billed CMS directly after not discouraging providers, who initially ordered testing within 14 days after an inpatient or outpatient discharge, from canceling the order and placing a new order for testing after the 14-day period.

"Caris Life Sciences intentionally deceived the public health care system to benefit from unlawful payments," Michael Driscoll, assistant director-in-charge, Federal Bureau of Investigation, New York Field Office, said in a statement. "Medicare fraud, in all its many forms, puts public health at risk and hands taxpayers the bill. We will continue to work with our partners to ensure programs like Medicare remain free from fraudulent activity."

DOJ said the civil settlement includes the partial resolution of one action and the final resolution of another action brought against Caris under the whistleblower provisions of the False Claims Act.

It added that the resolved claims are allegations only, and there has been no determination of liability.