Medical lab to pay $1.2M for false Medicare and UMWA benefit claims

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CHARLESTON, WV (WOWK) – The U.S. Attorney for the Southern District of West Virginia announced a $1.2 Million settlement Friday on a billing scheme that defrauded Medicare and several United Mineworkers benefit plans.

US Attorney Mike Stuart says the $1.2 million settlement “..demonstrates my office’s commitment to protect critical Medicare dollars and union-affiliated benefit plans from fraud and abuse.”

Stuart says the fraud claims were made by Great Lakes Medical Laboratory, Inc. (Great Lakes) which routinely tested urine and blood samples referred by medical providers in West Virginia and elsewhere at a Michigan medical reference laboratory.

From January 2016 thru May 2017, Great Lakes presented at least 21,732 claims to Medicare and the UMWA Funds which also included separate claims for reimbursement on services which had already been submitted.

Investigators also found that in some cases some of the claims were for services physicians hadn’t actually ordered, indicating the services possibly never happened at all.

The false claims to the UMWA Funds and Medicare amounted to more than $600,000 and the settlement doubles that figure.

In addition to Medicare, the false claims were filed against the United Mine Workers of America 1992 Benefit Plan, the 1993 Benefit Plan, and the Combined Benefit Fund (UMWA Funds).

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