Acting U.S. Attorney for the Northern District of California Stephannie Hinds said the defendants “turned a blind eye to compliance.” They “bilked insurance providers with fraudulent reimbursement requests, a practice that inevit
ably would result in higher premiums for us all. Further, defendants cashed out on the investment that flowed into the company to benefit themselves.”
The DOJ’s indictment described how the defendants implemented fraudulent practices related to UBiome’s clinical rests. The company’s alleged illegal practices included the following:
- submitting fake reimbursement claims or re-tests or re-sequencings of archived samples;
- utilizing a captive network of doctors and other health care providers who fraudulently were given partial and misleading information about the test requests they were reviewing;
- submitting reimbursement claims with respect to tests that had not been validated under applicable federal standards and/or for which patient test results had not yet been released;
- manipulating dates of service to conceal uBiome’s actual testing and marketing practices from insurance providers, and to maximize billings;
- fraudulently not charging patients for patient responsibility required by insurers, and instead, in some cases, incentivizing them with gift cards, and then making false or misleading statements about, or concealing, those practices from insurance providers;
- falsifying documents, using the identity of doctors and other health care providers without their knowledge or authorization, and lying to insurance providers in response to requests for information, overpayment notifications, requests for recoupment of billings, denials of reimbursement requests, or audits investigating uBiome’s billing practices.
Have a story you want USA Herald to cover? Submit a tip here and if we think it’s newsworthy, we’ll follow up on it.
