Horizon Blue Cross Blue Shield of New Jersey is suing Avee Laboratories, Alere Toxicology, Laurie Deerfield, DO, and Leading Edge Recovery Center, a substance abuse treatment center, for $36 million in damages and penalties related to the submission of false and fraudulent claims for urine toxicology testing.
Horizon’s Allegations against Avee, Leading Edge and Dr. Deerfield
Horizon claims Avee used false and deceptive marketing materials and offered illegal inducements to convince health care providers to perform medically unnecessary point of care urine toxicology tests (POCT) and then send the samples to Avee for unnecessary confirmatory testing.
Horizon alleges Leading Edge Recovery Center and Dr. Deerfield, Leading Edge’s medical director, performed medically unnecessary POCT and confirmatory testing. Even though patients had multiple negative POCT tests, Horizon says Dr. Deerfield and Leading Edge ordered confirmatory testing despite the fact they had no reason to believe the POCT were inaccurate.
Alee apparently had providers use “Custom Test Panel” order forms that enabled the providers to simply check a box that authorized Avee to perform multiple unnecessary tests on a single urine sample. Many of these forms lacked a provider signature, according to Horizon.
The complaint goes on to claim Avee also told providers confirmatory testing of POCT was required by CLIA when it is not and waived patient co-pays so patients would not object to testing.
Since 2009, Horizon states it paid Avee Labs and health care providers more than $24 million and $12 million, respectively.
As a result of the aforementioned tactics, Horizon says some providers increased their POCT claims by as much as 5,000% between 2009 and 2013.