NEW YORK – The US Department of Justice announced this week the resolution of two separate laboratory fraud cases, one in which a North Carolina lab allegedly billed Medicaid for unnecessary urine drug tests and another in which a Californian women submitted fraudulent claims for respiratory pathogen panel (RPP) testing.
In the North Carolina case, Paul Fribush, owner of Greensboro-based Substance Abuse Treatment Labs, agreed to pay $850,000 to resolve civil allegations that the lab violated the False Claims Act.
According to the government, between January 2018 and January 2022, Fribush and his lab submitted medically unnecessary claims for urine drug testing to North Carolina Medicaid. The DOJ noted that the claims resolved by the settlement are allegations only and that there has been no determination of liability.
In the California case, Lourdes Navarro was sentenced to nine years in prison for her role in a scheme in which she and Imran Shams, together co-owners of Matias Clinical Laboratory, doing business as Health Care Providers Laboratory (HCPL), submitted claims to government and private payors for respiratory panel tests that were medically unnecessary and never ordered by healthcare providers. Navarro was also ordered to forfeit $11,662,939 in funds that the government had previously seized and to pay $46,735,400 in restitution.
According to the government, between June 2020 and April 2022, Navarro and Shams obtained nasal swab specimens from residents and staff at nursing homes, assisted living facilities, and rehabilitation facilities and students and staff at primary and secondary schools in order to screen for COVID-19 infections. They then ran unnecessary RPPs on these specimens at Matias Clinical Laboratory, dba Health Care Providers Laboratory, where Navarro was a manager, and submitted $359 million in claims for that testing, receiving roughly $54 million in reimbursement.
Navarro pleaded guilty in October 2023 to conspiracy to commit healthcare fraud and wire fraud. Shams pleaded guilty to conspiracy to commit healthcare fraud and was sentenced to 10 years in prison on Jan. 30, 2024.