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BioReference Settles False Claims, Kickback Allegations for $11.5M

NEW YORK – The US Attorney for the Southern District of New York announced Tuesday it has settled improper billing allegations against BioReference Laboratories for $11.5 million.

From 2009 to 2012, the laboratory allegedly billed Medicare and Tricare for hospital inpatient testing listed on the Clinical Lab Fee Schedule that should have been billed to hospitals directly. Under the inpatient prospective payment system, hospitals receive payments for all items and services provided to the patient from federally funded programs. By billing Medicare and Tricare, BioReference received reimbursement for tests that had already been paid for. 

The complaint also alleged BioReference donated the cost of electronic medical records software to physicians' practices "based solely on the volume of business generated by those practices," according to a statement from the US Attorney's office. 

As part of the settlement, the Elmwood Park, New Jersey-based Opko Health subsidiary admitted to paying for EMR software to 69 practices based on whether the office would generate revenue equal to three times the value of the EMR software. $1.4 million of the settlement will be used to resolve the false billing claims, and $10.1 million will be used to resolve the kickback claims.